Wet Day Centres Report - University of Stirling · Wet Day Centres in the United Kingdom: A Research Report and Manual Commissioned by The King’s Fund and Homelessness Directorate

Wet Day Centres in

the United Kingdom: A Research Report and Manual

Commissioned by

The King’s Fund and Homelessness Directorate

Maureen Crane and Anthony M. Warnes

Sheffield Institute for Studies on Ageing University of Sheffield

October 2003

CONTENTS

The research team and acknowledgements

Summary

RESEARCH REPORT

R1 Background to the study and its methodology

R2 Punitive and supportive measures to tackle street drinking

R3 An overview of wet centres and drop-in centres for street drinkers

R4 The performance of four wet centres

R4 Wet centre clients

GUIDANCE MANUAL

Aims and structure of the manual

M1 Determining the clients to be served and the centre’s aims

M2 Planning and setting up a wet centre

M3 Working with the clients

M4 Managing the centre

The research team

Maureen Crane and Tony Warnes of the Sheffield Institute for Studies on Ageing (SISA),

University of Sheffield, were responsible for the study and the research report and guidance

manual. They also undertook some of the interviews. Aggie Crawford, Ruby Fu and Jayne

England carried out many of the interviews with clients, staff, police officers, and local business

proprietors. The research team has been supported by the clerical staff at SISA, and we

particularly thank Kate Smith.

Acknowledgements

We are most appreciative and grateful to the clients, staff, session workers and others who

participated in the study and agreed to be interviewed. Without their help, support and

willingness to share their experiences and opinions, this study would not have been possible. We

received exceptional co-operation from the staff and clients at the four wet centres that were

studied in detail – the Anchor Centre in Leicester, the Booth Centre in Manchester, the Handel

Street Centre in Nottingham, and Tollington Way (formerly the Finsbury Park Street Drinkers’

Initiative) in north London. We are also extremely grateful to the many wet centre managers and

other staff who gave up their valuable time to comment on the early draft of the report, and attend

the workshop in London (see below). This event generated very useful feedback which has

helped to structure this final report.

We also express our appreciation of the advice, practical help and guidance given by

David Jones of the King’s Fund, and Kate Noble and Helen Jones of the Homelessness

Directorate. We lastly thank the King’s Fund for hosting the study workshop.

Attenders at the workshop on the draft report:

John Chalmers, Anchor Centre, Leicester; Paddy Chandler, Handel Street Centre, Nottingham;

Amanda Croome, Booth Centre, Manchester; Toby Blake, Oxford Day Shelter, Oxford; Gary

Harvey, Housing Department, Nottingham City Council; Lisa Barker, Housing Department,

Leicester City Council; Richard Phillips, Alcohol Concern; Nancy Rotem, NORCAS, Great

Yarmouth; David Jones, King’s Fund; Helen Jones, Homelessness Directorate.

Summary

This document reports a short study of the work of ‘wet’ day centres in England for street drinkers – in other words, centres where drinking is allowed. It has two parts, an account of the research undertaken and its findings (Chapters R1-R5), and a ‘development manual’ in the form of guidance notes for those who are considering both the need for and how to establish similar facilities (Chapters M1-M4).

The Research Section

• The background to the study and its methods are described in the first chapter. The aims were to produce a directory of wet day centres across England, and to collect detailed information about the operations of four.

• Over the years, both punitive and supportive measures have been used to tackle the problem of street drinking. More recently, drinking bans have been introduced in many town and city centres. At the same time, services for homeless people with alcohol problems have expanded, with the development of wet hostels and supported housing projects for heavy drinkers. Chapter R2 reviews these various approaches, and comments on the paucity of information about effective ways to tackle long-standing alcohol proble ms.

• Chapter R3 is a directory of wet centres and drop-in centres for street drinkers in the UK. The first wet centre was established in Dundee in 1978, and in 1991 the first in England was set up in Nottingham. Others have subsequently been developed in London, Brighton, Oxford, Leicester and Manchester. The chapter overviews the development and work of these centres, and demonstrates their diverse organisational structures, funding, staffing arrangements and service profiles.

• The fourth chapter provides summary information about four wet centres that were studied in detail: Tollington Way in north London, Booth Centre in Manchester, Handel Street Centre in Nottingham, and the Anchor Centre in Leicester. The services that they provide and their ways of working with clients differ, although most have crucial input from street outreach teams and specialist primary health, mental health and substance misuse agencies.

• Interviews were conducted with 101 wet centre clients, and Chapter R5 summarises their characteristics and problems, the help that they have received, and their opinions of wet centres. It describes the vulnerabilities of this client group, many of whom have dual or triple mental health, alcohol and drug problems. Most are or have been homeless. Even among those who have tenancies, many are struggling to manage at home, have rent arrears and debts, and require tenancy support.

The Guidance Manual

• Wet day centres have two over-arching aims: (i) to provide support, help and treatment for severely disadvantaged and chaotic people, including street drinkers, who are excluded from other services; and (ii) to tackle an anti-social behaviour problem in a constructive, non-criminalising way. The first chapter in this section (M1) reviews these two aims and provides guidance on the factors that should be taken into account when making a detailed

specification. The precise aims will be a function of the groups of clients to be served, and the extent to which the key roles are or can be undertaken by other facilities.

• Chapter M2 describes many issues that need to be considered and the steps that should be taken when planning and setting up a wet centre. It discusses the kind of organisation that should run the centre, the optimum location, finding premises, overcoming local opposition, gaining planning permission, funding sources, and the role of various specialist service providers including the police. Many of the existing wet centres experienced problems with finding premises and local opposition, and for some several years elapsed from the recognition of a need to the establishment of the centre.

• The third chapter (M3) describes the work that needs to be undertaken with wet centre users who have alcohol problems. It describes ways of engaging with the clients, assessing their needs, meeting their basic needs, individual case-work, addressing alcohol problems, and the role of activities. The wet centres have different rules about drinking alcohol on the premises, and the merits of different policies are discussed.

• Managing a wet centre is not easy and several difficulties and stresses are discussed in Chapter M4. There is particular attention to the specification of the roles, training, supervision and support of staff. The problem of the rarity of apparent success and its effect on job satisfaction is addressed. The work involves helping clients who have been drinking heavily for years, and very often progress is slow. Moreover, it is usual for the clients who stop drinking to stop attending, and the staff may be unaware of the positive outcomes of their work.

• The final chapter (M4) also describes the ways of maintaining control in the centre so that neither bullying, intimidation nor immoderate drinking occurs. Examples are presented of the procedures used by existing centres to manage the local environment and to minimise the centre’s impact on the neighbourhood. The importance of setting standards, targets, and efficient performance recording and monitoring systems is made clear, not least so that wet centres can demonstrate their achievements and secure continuation funding.

• Low threshold, point-of-contact wet day centres play an important and successful role in working with street drinkers, rough sleepers and other groups of street people who are excluded from or have difficulty in accessing existing services. They link them into specialist or mainstream agencies, and help them not only to desist from anti-social behaviour but also in many cases to make constructive changes in their lives.

• The functions should therefore be established in any town or area with street drinkers and other marginalised and vulnerable ‘street people’. The precise form of the facilities that provide the functions should however be decided locally, following widespread and multi-agency consultation, and in the light of the capacities and development potential of the area’s existing facilities and organisations.

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R1 Background to the study and its methodology

This study of wet day centre provision in England was commissioned by the King’s Fund and the

Homelessness Directorate. Following the King’s Fund award of a grant to the Finsbury Park

Street Drinkers Initiative in north London (now known as Tollington Way), its Grant Committee

were interested to find out more about the different ways in which wet centres worked.

Discussions were held with the Homelessness Directorate and the organisations agreed to

commission jointly a short study of the different approaches adopted by wet centres and to

disseminate the findings. The study commenced in May 2003 and data collection was completed

in September 2003.

Aims and objectives

The aims and objectives of the research were:

• To produce a directory of wet and wet /dry day centres across England.

• To collect detailed information about the operations of four wet centres.

• To assess the main factors that encourage or inhibit the development of wet centres, and their effect on the local area in terms of street drinking.

• To review how the development of wet centres and other projects for street drinkers might inform future national initiatives, e.g. the National Alcohol Harm Reduction Strategy, and the work of The Homelessness Directorate.

• To produce a research report and manual about the setting up and running of wet day centres.

Methodology

The research has elements of a review, a synthesis of basic facts, and an exploration of the roles of

the wet centre services and of their effectiveness for both the clients and localities (whether city-

centres or suburban neighbourhoods).

i. Directory of wet centres and drop-in centres for street drinkers

A directory has been compiled of all ‘wet’ centres known to be operating in the UK, i.e. centres

that target street drinkers and permit drinking on the premises either in designated rooms or in the

garden. Details have also been included about day centres that either target street drinkers but do

not allow drinking on the premises, and generalist homeless people’s day centres that have a

designated ‘wet area’ for drinkers. The centres were identified by contacting the managers of

known wet day centres, by contacting homeless people’s services in different locations and

enquiring about local provision for drinkers, and by online searches.

Eight wet day centres in England and one in Dundee were identified. Visits were made to

all the centres in England, and information gathered from the managers about: (i) development,

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objectives, services provided, and funding; (ii) staffing arrangements, including recruitment and

retention; (iii) client characteristics, including whether housed or homeless, and their problems

and needs; (vi) ways of working with the clients and help given; and (v) the centre’s relations with

the neighbourhood, local authority, police and other agencies, especially health, alcohol, housing

and social services staff. Brief information was collected on the other centres through visits to

Ben’s Place in Sheffield, the Cornerstone Day Centre in Manchester, and the Homeless Alcohol

Recovery Project in Birmingham, and through telephone interviews and documentation. Contact

was also made with service-providers in other towns and cities where searches had identified that

day centre facilities for street drinkers were planned.

ii. Detailed study of four wet day centres

A detailed study of four wet centres was undertaken: Tollington Way in north London; Booth

Centre in Manchester; Handel Street Centre in Nottingham; and the Anchor Centre in Leicester.

These were selected as they were believed to work in different ways with street drinkers.

Tollington Way allows drinking on the premises, while the Booth Centre permits drinking in the

garden and provides a service to drinkers alongside an activities-based day centre. The Anchor

Centre works with street drinkers together with drug misusers, while the Handel Street Centre,

which is managed by Framework Housing Association, has been in operation for a decade and

also provides a tenancy support service. Table R1.1 enumerates the interviews undertaken at each

of the four centres.

a. Review of documents and reports

Documents on the genesis, history, external relations and performance of each centre were

reviewed, with particular attention to recent usage and evaluation reports.

Table R1.1 Interviews conducted at the wet centre s

People interviewed Handel Street

Tollington Way

Booth Centre

Anchor Centre

Total

Clients 25 25 25 26 101

Centre managers and core staff1 9 7 6 6 28

Outreach workers 1 n.a. 1 2 4

Health and social service workers 5 1 2 3 11

Police 2 1 1 1 5

Stakeholders 2 0 2 1 5

Local businesses and residents 0 1 0 2 3

Total number 44 35 37 41 157

Notes: I. Includes two interviews with volunteers and an interview with the art tutor at the Booth Centre, Manchester. n.a. not applicable.

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b. Interviews with the centre manager and core staff

Interviews were conducted with the centre managers and core staff, and details gathered on: (i) the

origins and development of the centre, including the acquisition of premises and negotiations for

funding; (ii) the centre’s objectives, changes over time, and services provided; (iii) the

recruitment, experience, training and retention of staff; (iv) funding arrangements; (v) the role of

staff, assessments of client needs, case-work, and help given at the centre; (vi) performance

measures and outcome monitoring; (vii) inputs from health, alcohol, social services and housing

workers; (viii) the centre’s relationship with the local community, local authority, police and other

key statutory agencies; and (ix) their views of wet centres, lessons learned, and the potential and

limitations of the centre. Two volunteers at the Booth Centre were also interviewed. Check-lists

guided all interviews.

c. Interviews with session workers

Interviews were conducted with session workers at the centres, including health and substance

misuse workers, street outreach teams, and social workers. Information was gathered about: (i)

their input at the centre; (ii) the help that they give to the clients; and (iii) their views of the wet

centre, and its potential and limitations for street drinkers. Check-lists guided all interviews.

d. Interviews with clients

Interviews were conducted with 25 clients at each centre (26 at the Anchor Centre). Using a

questionnaire of closed and open-ended questions, information was gathered on: (i) personal

characteristics; (ii) recent housing history and experience of homelessness; (iii) physical and

mental health problems, and treatment; (iv) alcohol and drug problems, and treatment; (v) history

of drinking, street drinking patterns, and recent problems with the police; (vi) financial situation,

daily living and household skills, and help at home; (vii) use of the wet centre, reasons why they

use it, help received, and changes in their housing and drinking since attendance; (viii) use of

other centres; and (ix) opinions of the wet centre, and help that they would like but are not

receiving.

Information from the clients’ interviews has been coded and entered into an SPSS

database. Their characteristics, problems and needs, help given, and their opinions of the wet

centres have been examined. Comparisons have been made by age, housing situation, and the

centre that they attend.

e. Interviews with stakeholders and other agencies

Interviews were conducted with stakeholders and other agencies with an interest in the day centre,

to gather their opinions about the benefits and potential of the centre. Included were the police in

all four locations, the Head of Hostels and Housing Community Care Service in Leicester

Housing Department, and the Homelessness Co-ordinators in Nottingham and Manchester local

authority housing departments.

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f. Assessment of local situation

An assessment of the environs and regulatory context of each centre was undertaken to gauge the centre’s influence on street drinking and impact on the local community. There was: (i) a review of local policies, procedures and reports relating to street drinking in the locality; (ii) interviews with the manager of a neighbouring hous ing complex in Leicester and business proprietors in London and Leicester who had concerns about the wet centres; (iii) interviews with the local community police officers; and (vi) street outreach work was carried out twice in London and once in Manchester with outreach workers to meet street drinkers who did not use the wet centres and to find out the reasons.

The centres in London and Nottingham were studied first, and then those in Leicester and Manchester. It was not possible to interview all session workers, stakeholders and local businesses. This was partly due to time constraints, and partly because the study was conducted over the summer when staff were on holiday or unable to spare the time to be interviewed.

iii. Review of literature and policy documents

A literature search was conducted of research and evaluation studies of day centre and related interventions with heavy drinkers and street drinkers. Standard scientific abstract databases were used, as well as the catalogues and resources of The King’s Fund, Alcohol Concern, and the Institute of Alcohol Studies. Policy documents were also reviewed, and interviews were conducted with the Director of Policy and Services at Alcohol Concern, and the Senior Policy Officer for Alcohol and Drugs at the Greater London Authority.

iv. Workshop to discuss draft report

A draft report of the study was prepared and circulated in early September 2003, and a workshop held at the King’s Fund on 11th September 2003 to discuss the report and the study’s findings. It was attended by: four wet centre managers (Booth Centre in Manchester, Handel Street Centre in Nottingham, Anchor Centre in Leicester, and Oxford Day Shelter in Oxford); the Homelessness Co-ordinator in Nottingham City’s Housing Department; the Head of Hostels and Housing Community Care Service in Leicester City’s Housing Department; the Director of Policy and Services at Alcohol Concern; a worker who is involved in developing a local wet centre from NORCAS, an outreach team in Great Yarmouth; and the study commissioners and researchers.

The report

This report has two sections. The first concentrates on the findings of the research and has four chapters on: a review of punitive and supportive measures to tackle street drinking; an overview of wet centres and drop-in centres in the UK for street drinkers; a description of the performance of the four wet centres that have been studied in detail; and an account of wet centre clients and their views of the centres. The second section of the report is a manual and guide to the design, planning and running of a wet centre for street drinkers and other indigent and exceptionally vulnerable people. It is based on the findings of the research.

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R2 Punitive and supportive measures to tackle street drinking

Alcohol consumption in England and Wales has received increasing attention in recent years,

partly because deaths directly attributable to alcohol increased from 2,500 in 1979 to almost 6,000

in 2001 (Alcohol Concern, 2003). A ‘National Alcohol Harm Reduction Strategy’ is currently

being prepared. Street drinkers are one of the most vulnerable groups in society. There are no

official figures of their number, but in 1995 a Mental Health Foundation Working Group

estimated that there were between 5,000 and 20,000 persistent street drinkers in England and

Wales (Mental Health Foundation, 1996). Over the years, both punitive and supportive measures

have been used to tackle the problem of street drinking. These are reviewed in this chapter.

Many street drinkers have chronic alcohol and physical and mental health problems, and

most are homeless or have housing-related problems. They drink on the streets for company,

because the prices in public houses are high, and because some live in hostels with alcohol bans.

Many have been drinking on the streets for a long time. Among 43 street drinkers in the London

Boroughs of Camden and Islington, 68% had been drinking outside for more than five years.

Two-thirds drank on the streets every day, and nearly ha lf spent less than five hours each day

indoors (Vision Twentyone, 2000). They have high risks of assault and of arrest for drunkenness,

shoplifting and other public order offences (Alcohol Concern, 2001). Many receive little or no

help from mainstream health and social services. Their chaotic behaviour means that many have

been barred from or cannot cope with the rules and procedures of generic services.

Punitive measures to tackle street drinking

Recent governments have been concerned about several forms of street homelessness behaviour,

namely rough sleeping, street drinking, begging, and drug dealing and taking, which are regarded

as anti-social and damaging to the quality of public spaces and residential areas. Attention has

been given to the impacts on residents, shoppers, tourists and local businesses. According to

Shelter (2001, p. 4), ‘street homelessness is one of the most acute symbols of the failure of social

policy’. Street drinkers, particularly in groups that commandeer prominent spaces in town centres

and parks, are perceived by the public as intimidating, and businesses are aggrieved by the

damage they cause to their trade (Shimwell, 1999; Vision Twentyone, 2000).

Attempts to control street drinking date back years. ‘As soon as the Hastings police force

was formed in 1836, it had to deal with street drinkers, whose main crime (then as today) was to

make the place look untidy’.1 Over the years, habitual drunken offenders have been detained by

the police until they were sober. Since the late 1980s, local measures to curb street drinking have

gradually spread. In 1988 seven local authorities, including Coventry, took part in a two year

pilot to test the effectiveness of a byelaw making it an offence to drink alcohol in designated

1. See http://www.victorianweb.org/gender/wojtczak/under.htm.

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places after being warned not to do so by a police officer (St John-Brooks and Winstanley, 1998).

An evaluation concluded that the byelaw should be made more widely available. In 1990, the

Home Office issued a model byelaw entitled, Consumption of Intoxicating Liquor in Designated

Places, which was subsequently revised. Before passing such byelaws, local councils had to

review the problem of street drinking in their area for six months, and then apply to the Home

Office for permission. Byelaws could not ban drinking throughout a town or city, only on

specified streets or in areas such as parks. By 2001, 100 local authorities had drinking byelaws

(Alcohol Concern, 2001). Similar byelaws in Scotland date back to 1989, when they were piloted

in areas of Motherwell, Dundee and Galashiels.

The Crime and Disorder Act 1998 (Sec. 1a) introduced anti-social behaviour orders against

an individual acting in ‘a manner that caused or was likely to cause harassment, alarm or distress

to one or more persons not of the same household as himself’. Either the police or the local

authority can apply for an order, and an individual is expected to desist from a particular activity

for a minimum of two years. Persistent problematic behaviour associated with alcohol misuse is

liable to an anti-social behaviour order. The Act also requires each local authority to produce a

Community Safety Strategy’, with the involvement of the police, probation service, health trusts,

and the voluntary sector. Some councils, e.g. Wigan, Lewis ham and Hammersmith & Fulham,

have introduced wardens and outreach workers to work with street drinkers as part of their

community safety strategies.

The Criminal Justice and Police Act 2001 (Ch 16, Secs. 12-16) clarifies the powers of the

police to stop drinking in public places. Local authorities can create alcohol-free zones in

designated places, and police officers can confiscate alcohol from people in these places if there is

reasonable belief that the person is drinking or intends to drink. Failure to hand over drink can

result in arrest and a maximum fine of £500. The police have discretion over when to act. The

local authority has to consult various people before an order can be made to designate a place an

alcohol-free zone, including the Chief Officer of Police for the proposed area, the local authority

and the Chief Officer of Police in neighbouring areas, local licensees, and a notice of intent has to

be put in a local newspaper and representations invited.

Supportive measures to tackle street drinking

Since the 1970s, reports have identified the vulnerability and unmet needs of single homeless

people who are socially inadequate and chronic alcoholics. Recommendations were made that

help and treatment should be provided by psychiatric and soc ial services rather than through the

criminal justice system (Archard, 1979; Home Office, 1971; 1974). In 1973 the responsibility for

dealing with habitual drunken offenders was transferred from the Home Office to the then

Department of Health and Social Security (DHSS). The DHSS offered funds to voluntary bodies

to provide services for people with alcohol problems, and specialist hostels, detoxification centres

and rehabilitation programmes were established. The DHSS supported two detoxification centres

where drunken offenders could be taken by the police (rather than police cells). These were the

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Leeds Detoxification Centre which opened in 1976 and is managed by St Anne’s Shelter and

Housing Action, and a unit at the Withington Hospital in Manchester which opened two years

later. In 1981, the Home Office funded a centre in Birmingham that was open overnight for

alcoholics. The Leeds centre is the only one still operating.

By the mid-1980s, services began to recognise that some heavy drinkers were reluctant or

unable to abstain, as required of their clients by many alcohol services. One response has been

the creation of ‘wet’ and ‘damp’ projects for homeless people who are heavy drinkers. ‘Wet’

projects allow drinking on the premises, while ‘damp’ schemes target heavy drinkers but disallow

alcohol consumption in the project. Their aim is ‘harm minimisation’ – they encourage controlled

drinking and less dangerous substitutes, and promote healthier and more stable lifestyles. Wet

hostels and supported housing projects began in the mid-1980s, with the establishment in 1985 of

the Heavy Drinkers Project in Manchester by Peterloo Housing Association (now run by

Manchester Methodist Housing Association), and of Wernham House in Aberdeen in 1986 by the

Aberdeen Cyernians. The first UK wet day centre opened in Dundee in 1978, and the first in

England was established in Nottingham in 1991 (described in Chapter R3).

Services for homeless people with alcohol problems have expanded since the mid-1990s

with funding from the former Rough Sleepers Initiative, the former Rough Sleepers Unit, the

extant Homelessness Directorate, and from the Department of Health’s Drug and Alcohol Specific

Grant. Compared to drug services, however, funding for alcohol services is poor. Some towns

and cities now have wet hostels and housing projects for heavy drinkers, but demand outstrips

supply and there are still only a handful of wet day centres. According to homeless sector staff,

accessing alcohol services for their clients is often difficult: services are few and there is often a

long wait (Bevan and Van Doorn, 2002; Crane and Warnes, 2001). This is particularly true for

those clients who have dual problems of alcohol abuse and mental illness or drug misuse.

The 1998 Green Paper, Our Healthier Nation, announced a national strategic approach to the

treatment of alcohol abuse. A Strategy Unit in the Cabinet Office was formed in July 2002 which

with the Department of Health aimed to implement a National Alcohol Harm Reduction Strategy

for England by 2004. A consultation paper on the strategy was circulated in October 2002

(Strategy Unit and Department of Health, 2002), and an Interim Analytical Report in September

2003 (Strategy Unit, 2003).

The effectiveness of the various approaches

A few local studies of street drinkers have been conducted (e.g. Morrish, 1993; Holman, 1994;

Vision Twentyone, 2000), but there has been little rigorous research into effective ways of

tackling long-standing alcohol problems. The UK Alcohol Research Forum recently noted the

paucity of research into alcohol problems (Alcohol Concern, 2002). For several years,

detoxification has been promoted as an initial step in helping a person to abstain from alcohol, and

as a respite measure for some who wish to temporarily withdraw. Many street drinkers have

participated in numerous detoxification programmes. There is now evidence to suggest, however,

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that multiple episodes of alcohol withdrawal may increase the incidence and severity of seizures

during detoxification, render a person more vulnerable to brain damage, and contribute to alcohol-

related neuropathology and increased cognitive dysfunction (Becker, 1998; Littleton, 1998). It is

alleged that for the most part, ‘treatment advances [detoxification] have evolved independently

from developments in neurochemical understanding’ (Littleton, 1998, p. 13).

The use of drinking bans has spread widely in the last few years, but little is known of their

implications. They may benefit local people and bus inesses, but their impact on street drinkers

and the wider community is less clear. Where local authorities have introduced a drinking

byelaw, the result has sometimes been a displacement of street drinkers from town centres to

residential areas (St John-Brooks and Winstanley, 1998, p. 9). This could lead to street drinkers

becoming more marginalised if they are unable to access services in central locations, and if

outreach workers have difficulty finding and working with them. In its response to the National

Alcohol Harm Reduction Strategy Consultation, Homeless Link recommended the commissioning

of research to understand better the needs of street drinkers and the effects of controlled drinking

area policies upon them.

There is little evidence of the most effective ways to tackle the complex health and

alcohol problems, poor motivation, and chaotic lifestyles of many street drinkers. Many move in

and out of hostels and tenancies, and return to the streets when rehousing fails or they are barred

from services. Interventions that help control drinking and stabilise chaotic patterns of behaviour

are at an early stage of development. Some wet hostels and day centres have been operating for a

few years, yet there has been little evaluation of their services to assess the short and long-term

outcomes of various ways of working. This study is short and does not have the capacity to carry

out a thorough and full systematic evaluation.

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R3

An overview of wet centres and drop-in centres for street drinkers

This chapter overviews the work of wet centres and drop-in centres for street drinkers in the UK.

The early sections describe their origins and the difficulties of finding premises and establishing a

centre, and there is an inventory of their locations, funding, staffing and services. It includes all

‘wet’ centres known to be operating in the United Kingdom, i.e. those that target street drinkers

and permit drinking on the premises in either a designated room or garden. The last section

provides details of the few day centres that either target street drinkers but do not allow drinking

on the premises, or are generalist homeless people’s centres but have a designated ‘wet area’ for

drinkers. Three tables provide basic profiles of the centres’ services and funding, and contact

details are given at the end of each centre’s description.

Wet centres developed up to 2000

The Wishart Centre, Dundee

The first wet day centre in the UK was established by Dundee Cyrenians Wishart Centre Ltd in

1978 in the Wishart Memorial Church for local night-shelter residents. For its first ten years, the

service users were mainly middle -aged and elderly men who were heavy drinkers. In 1986 a

temporary Drug Problem Centre was opened on the premises and it was frequented by young drug

users. For a time the two groups co-existed, but in 1996 the Dundee Cyrenians opened a new

purpose-built centre providing 24-hour accommodation and support for drug users, and the day

centre re-registered as The Wishart Centre.

Contact deta ils: The Wishart Centre, 61 King Street, Dundee DD1 2LD. Tel: 01382 2296671.

Handel Street Centre, Nottingham

The first wet day centre in England was established on the eastern edge of Nottingham city-centre

in January 1991 by Nottingham Help the Homeless Association (NHHA)1. Known as the Handel

Street Centre, it came about because of an increase in the number of street drinkers in the city

during the previous few years, which had led to public and political complaints and concerns. The

City Council and the police proposed a wet centre in Nottingham which would permit drinking on

the premises. The Council first approached The Salvation Army and then NHHA about managing

such a facility. The purpose of the centre was: (i) to provide shelter, food and beverages during

the day to heavy drinkers, where there would be no pressure on them to move on; (ii) to provide

primary health care to heavy drinkers who did not access health services; and (iii) to reduce the

nuisance of street drinking.

NHHA expressed concerns that: (i) there would be little chance of carrying out effective

rehabilitation work with heavy drinkers in a day centre; and (ii) having around 25 heavy drinkers

1 In July 2001 NHHA merged with Macedon to form Framework Housing Association

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on one site would be too difficult to control, and levels of violence were likely to be unacceptably

high. It was finally agreed that both a wet hostel and a wet day centre would be run by a single

staff team. The hostel opened 14 months after the day centre. The day centre occupies a former

warehouse in a former retail market area with comparatively few residents, and is surrounded by

car-parks and warehouses, and is close to three homeless sector hostels. Nonetheless, there was

strong local opposition to the project at the planning stage. It initially opened every day from 10

a.m. to 6 p.m., and in its first year attracted 558 users. Of these, 93% were men, 58% aged 40-59

years, and 92% were homeless. An evaluation of the performance during the first year was

undertaken by a team from Nottingham University (Williams, 1992). The centre is described in

more detail in R4.

Contact details: Handel Street Centre, 4 Handel Street, Sneinton, Nottingham, NG3 1JE. Tel: 0115 841 7725. http:www.frameworkha.org

Tollington Way, north London

Tollington Way (formerly known as the Finsbury Park Street Drinkers Initiative) was established

following research commissioned in 1993 by the London Boroughs of Haringey, Islington and

Hackney into the needs of the drinkers that congregated in Finsbury Park, north London. The

local community had been concerned about the threatening behaviour of drinkers and beggars in

the park. Most were Irish men over the age of 40 years who had physical health problems and

were not in contact with local services. Following the study, an outreach worker (seconded from

Equinox) was funded by the three boroughs for 18 months to link the drinkers into services, but

found that few local services were prepared to work with the client group.

In 1996, a Development Co-ordinator was appointed to explore the possibility of

developing a wet centre in the area. One of the major obstacles was the scarcity of suitable

premises. As an interim measure, a local vicar (who was on the project’s Management

Committee) offered the church hall of St Thomas the Apostle two afternoons a week as a drop-in

centre. Islington and Shoreditch Health Authority then provided a building for the centre at

Blackstock Mews, Finsbury Park. The project opened at these premises in January 2000, but

from the outset there were problems. The building was at the entrance to a mews with small

businesses which alleged that the project had damaged trade, and there were complaints from

local residents. After a few months, Islington Council confirmed their support for the centre but

advocated a new location. In Septe mber 2001, it moved to Tollington Way, off the Holloway

Road in North London. The building is owned by Islington Council and had been a day centre for

Afro-Caribbean older people. The centre is described in more detail in R4.

Contact details: Tollington Way, 91 Tollington Way, London N7 6RE Tel: 0207 263 4140.

Old Steine Day Centre, Brighton

The Old Steine Day Centre in Brighton was opened as a wet centre by Equinox in September

1998. Street drinking had been a problem in Brighton town centre from the early 1990s. A multi-

11

agency forum, the Alcohol Partnership for East Sussex, was established to examine alcohol-

related issues, and the absence of a ‘wet’ facility was identified as a major gap in local service

provision. A ‘Drink Crisis Planning Group’ was convened, and a needs assessment undertaken to

identify the size and location of the street drinking population, and to audit existing service

provision. The Planning Group identified the need for a ‘low-threshold’ specialist day care

service that offered an alternative to street drinking and access to other services. The

recommended principles were that: (i) the service should not insist upon a high level of

motivation and commitment to eventual abstinence as a precondition of access; and (ii) there

should be a co-ordinated response by all relevant services to the needs of street and inadequately

housed drinkers, which took account of their reluctance to stop drinking, their chaotic lifestyles,

and their social isolation (Squires and Measor, 1999).

It took four years from the identification of a need for a wet centre in Brighton to its

establishment. Equinox agreed to manage the centre and spent more than a year in an

unsuccessful search for premises. The organisation eventually informed the Counc il that they

would have to withdraw if a building could not be provided. The Council offered a rental

building which used to be a bank and is adjacent to the Royal Pavilion gardens. This location

immediately raised concerns from local people, but the police who were represented on the

Planning Group supported the proposal. A three-year funding package was secured, comprising

money from the Single Regeneration Budget (SRB2), the National Lottery, Brighton and Hove

Council, the Department of Health Specific Grant, and the Tudor Trust. An evaluation of the

centre was carried out in 1999 by a team from the University of Brighton (Squires and Measor,

1999).

Contact details: Old Steine Day Centre, 62 Old Steine, Brighton BN1 1EH. Tel: 01273 202894.

Wet centres developed since 2000

Anchor Centre, Leicester

In June 2000, the Anchor Centre in Leicester, which had been an evening centre for male ex-

offenders for 30 years and a day centre since 1994, became a wet centre. Street drinking had been

a significant pr oblem in Leicester for several years, and was dealt with by the police mainly by

arrests and detaining street drinkers. In 1997, the City Centre Forum (of businesses, police and

other city organisations) proposed the introduction of a byelaw to ban street drinking. The City

Council Community Safety Partnership set up a Working Group in 1998 to examine the extent of

the problem and possible solutions. It found that the city centre and parks were particularly

affected; that young people and the homeless were believed to be the most common street

drinkers, and that 70% of the public supported the idea of a day centre to manage the problem.

There was little evidence to suggest that a byelaw would be effective, and therefore a wet day

centre was proposed. An estimated £248,000 per year would be saved through savings on arrests,

tenancy failures, hospital stays, policing, casualty admissions, health care, custodial sentences,

12

street maintenance and security. It was also estimated that £45,600 would be saved through a

street drinking ban (Leicester City Council, 1999).

The proposed wet centre became a priority in Leicester’s ‘Single Homeless Strategy’ and

‘Health Action Zone’ plans. Leicester City Council Housing Department became the lead partner,

and drew up a ‘memorandum of understanding’ with other partners, namely Leicestershire Health,

Leicestershire and Rutland Healthcare Trust, Leicestershire Constabulary, The Benefits Agency,

and the Leicestershire and Rutland Probation Service. Forge Midlands, part of Novas Ouvertures,

agreed to manage the wet centre, which was to be in an existing day centre. Funding was

obtained for two years from the Department of the Environment, Transport and the Region’s

‘Invest to Save Budget’, with matched funding from the partners equating to 42% and 25% in

each year. A ban on street drinking came into operation in the city centre in June 2002 (it

includes the area around the Anchor Centre). The centre is described in more detail in R4.

Contact details: Anchor Centre, 21-23 Dover Street, Leicester LE1 6PW. Tel: 0116 2551608.

Booth Centre, Manchester

The Booth Centre at Manchester Cathedral was opened in May 1995 as a drop-in and activity

centre for homeless people by an independent charitable organisation (The Booth Centre). Since

at least the late 1960s there had been recurrent problems with drinking schools in Piccadilly

Gardens at the eastern edge of Manchester’s main central shopping area. In August 2000, a

byelaw banning drinking on the streets in the city centre was introduced, and the area around the

Booth Centre became part of the ban. This had implications for the centre’s clients as some used

to congregate on the steps outside the centre and drink, and the staff would work with them

outside.

The decision was therefore made to establish a ‘wet garden’ adjacent to the Booth Centre on

a disused plot which belonged to and abutted the cathedral and had previously been a builder’s

yard. The idea for an ‘outdoor area’ originated from the centre users, and was put into action by

the centre staff and the Cathedral. The police and other statutory and voluntary agencies also

supported the proposal. The centre users were involved in the planning and building of the garden

with assistance from CRASH and the Community Technical Aid Centre. The wet garden opened

in September 2001 for two mornings a week, and funding was obtained from the Central and

North Manchester Primary Care Trust for a worker to provide support and help to the clients in

the garden. The centre is described in more detail in R4.

Contact details: The Booth Centre, Manchester Cathedral, Victoria Street, Manchester M3 1SX.

Tel: 0161 835 2499. http://www.boothcentre.org.uk

Oxford Day Shelter, Oxford

The Oxford Day Shelter (formerly known as the Luther Street Drop-in Centre) has been in

operation since 1999, partly to provide shelter and services during the day for Oxford’s night-

13

shelter’s users who were required to vacate the premises between 8 a.m. and 7 p.m (the night-

shelter and drop-in centre are at the same premises).

There had been strong pressure from Oxford’s business community to deal with the problem

of street drinking, and Oxford Night Shelter had worked with Thames Valley Police, Oxford City

Council and other agencies to tackle the problem. In May 2001, Oxford City Council developed a

‘Street Scene Task Force’ to tackle street drinking, aggressive begging, rough sleeping and drug

misuse. In November 2001, with financial support from the Rough Sleepers Unit and the

organisation’s own funds, a wet room was established where users are allowed to drink alcohol.

In October 2002, the council introduced six alcohol-free zones in the city centre. It now wants to

extend the alcohol-free zones to include the area around the project. The Oxf ord Day Shelter is

adjacent to the Luther Street Medical Centre.

Plans for a purpose-built night shelter and day centre on the site have been under

consideration for several years (whereupon the existing building would be demolished). The

Housing Corporation have agreed to fund the construction work which is due to start in

September 2003 and will take about 14 months. The new building will be managed by Warden

Housing Association, and the project will focus on rough sleepers and resettlement. During the

interim, the project will operate from portakabins in a nearby car-park.

Contact details: Oxford Day Shelter, PO Box 177, Luther Street, Oxford OX1 1SF. Tel: 01865

250153.

Specialist Dependency Service, Camden Town, London

The Specialist Dependency Service in Camden Town, London, opened in May 2003 as a wet

centre. It is managed by Bridge Housing Association, part of Novas Ouvertures, and uses the

same premises as the Spectrum Day Centre, a generalist day centre for homeless people managed

by the same organisation. Street drinking and begging had been a problem in Camden Town for

several years. In 2000, the Camden and Islington Street Population Strategy Group commissioned

a survey into patterns of street drinking and begging in the two boroughs. It was found that the

majority of the street population were not rough sleepers, and that many street drinkers had been

drinking outside for more than five years, were sceptical of services, and had difficulty changing

their way of life (Vision Twentyone, 2000).

It was proposed that there should be a wet centre in Camden Town, but neither Bridge

Housing Association nor the council could find premises. This was partly due to local opposition

to the scheme. The project was therefore established in an existing day centre. The wet centre

operates in the evenings and at weekends when the generalist day centre is closed. It is a one-

year pilot project, and is funded by the Borough housing department as part of its ‘Street

Population Strategy Action Pla n’. According to the centre manager, the Borough social services

department have expressed an interest in funding the project if the housing department withdraws

funding at the end of the pilot phase. The building is leased from a church which does not allow it

14

to be used on a Sunday. An exception has been made for the life of the pilot project but it is

unknown whether this could continue. At present there is no street drinking ban in Camden Town

but the idea is being considered.

Contact details: Specialist Dependency Service, 6 Greenland Street, London NW1. Tel: 020 7267

4937.

Other day centre provision for street drinkers

Anchorage Resource Centre, Omagh, Northern Ireland

The Anchorage Resource Centre in Omagh, Northern Ireland, was established in January 2000

and is open six days a week (not Sundays). It was initiated by the Omagh Street Drinkers

Consortium, and is managed by the Foyle Homeless Action and Advice Service. It targets street

drinkers but users are not permitted to drink alcohol on the premises. If they bring drink, it is

taken from them and returned when they leave. Entry is refused to anyone who is intoxicated.

Services provided include free food, an educational programme, computer-skills training,

recreational activities, and tenancy support work for clients who are housed. The staff arrange

medical appointments for the clients with local doctors, and the community addiction team has

weekly sessions at the centre.

Contact details: The Anchorage Resource Centre, 6a Old Market Place, Omagh, County Tyrone,

BT78 1BT, Northern Ireland. Tel: 028 8225 9444.

Ben’s Place, Sheffield

Ben’s Place in Sheffield is run by the charitable organisation Ben’s Centre for Vulnerable People .

It was opened in October 1996 by a town centre policeman, Ben Sherman, who perceived that it

was futile to lock up street drinkers. His vision was to provide a safe and warm environment for

Sheffield’s street drinkers where they could get nourishment and help. It was steered by a ‘lay

partnership committee’ drawn from Sheffield City Council, Yorkshire Water, the town centre

manager, and the police, with the City Council providing the premises. Ben’s Place targets street

drinkers but does not allow alcohol consumption in the centre. About four years ago it moved to

its current building which belongs to a church and is now for sale. The organisation therefore

seeks alternative premises.

Over the last few years it has had revenue problems. Its main funding was formerly from the

local authority social services department and the Health Action Zone. These monies were

withdrawn and it now relies solely on donations and funds from charitable trusts. This has

reduced the services that can be provided. It now opens just three days a week, and has had

difficultie s in recruiting experienced staff.

Contact details: Ben’s Place, 2 Institute Buildings, Rockingham Lane, Sheffield S1 4FW. Tel:

0114 276 7302.

15

Cornerstone Day Centre, Manchester

The Cornerstone Day Centre in Manchester is a generalist day centre for home less people which

opens five days a week (Monday to Friday). It has been in operation for 11 years and is run by

the Catholic Welfare Society. It moved about three years ago from a portakabin to its current

premises one mile south of the city centre. It is adjacent to a hostel for 14 men, the Morning Star,

which requires the residents to leave the premises between 10.30 a.m. and 4 p.m. This led to

complaints by the neighbours to the police about street drinking during the day, primarily by the

men from the hostel. One resident became very abusive to the local children when under the

influence of alcohol. In May 2003, the Cornerstone Day Centre designated one room as a wet

facility exclusively for the men from the Morning Star hostel. About eight older men use the

room regularly.

Contact details: Cornerstone Day Centre, Denmark Road, Manchester M15 6JS. Tel: 0161 232

8888.

Harold Tomlins Day Centre, Chester

Harold Tomlins Day Centre in Chester was opened in September 2001 by ‘Chester Aid to the

Homeless’ as a day centre for homeless people. Street drinkers had been causing problems in the

town centre and there had been complaints from shopkeepers, so the Council allocated a building

to be used as a day centre for homeless people on the proviso that it had a wet area for drinkers.

The day centre is open seven days a week from 8 a.m. to 6 p.m., and provides meals, physical and

mental health services, chiropody, counselling, IT and literacy training, and resettlement

(http://www.homelessnessinchester.org/htdc.html). There is a small, designated wet room in the

centre where alcohol can be consumed, and it can accommodate six people at any given time.

The amount of alcohol brought into the centre is restricted to four cans of beer, or half a bottle of

spirits, or two litres of cider. People who are severely intoxicated are not allowed in.

Contact details: Harold Tomlins Day Centre, Grosvenor Street, Chester CH1 2DD. Tel: 01244

409158. http://www.homelessnessinchester.org/htdc.html

Homeless Alcohol Recovery Project (HARP), Birmingham

The Homeless Alcohol Recovery Project (HARP) in Birmingham was established in 1983 with

support from the Probation Service to provide help for homeless street drinkers in central

Birmingham. Starting with a drop-in service, the organisation has over the years developed

various services for drinkers and now has a staff of 22. It has two drop-in centres (both open five

days a week; the main one for 1½ hours, and the other for one hour). Clients are not allowed to

drink alc ohol at these sessions. After the drop-in sessions, key-working and counselling is

undertaken with the clients at the main drop-in centre. Other HARP services include street

outreach work, advice work, counselling, resettlement, tenancy support work, and criminal justice

work. The organisation also has three supported houses with a total of 27 beds where residents

stay for six months. Other services that visit the main drop-in centre include drug workers, a

16

nurse, a chiropodist, and a worker from Crossmatch Solutions (basic skills, training and

employment).

Contact details: HARP, Ground Floor, 18/28 Lower Essex Street, Birmingham B5 6SN. Tel:

0121 6667023. http://www.harpbirmingham.org.uk.

Teesside Homeless Action Group Information and Resource Centre, Redcar, Teesside

The Teesside Homeless Action Group is a self-help group of homeless and ex-homeless people

which formed in 1997. It has established an Information and Resource Centre in Redcar for

homeless people which opens six days a week (not Sundays) from 9.30 a.m-7 p.m. (12p.m - 4

p.m. on Saturdays). There are various activities for the clients, including Internet access and a

community gardening project. There is a yard at the back of the centre where attenders are

permitted to consume alcohol. The organisation is also involved in setting up a wet centre in

Middlesbrough.

Contact details: Teesside Homeless Action Group, 145 High Street, Redcar TS10 3DQ. Tel:

01642 478885. http://www.oneworld.org/teeshomeless

Summary

There are only a few wet centre facilities for street drinkers in the UK. Most have been

established as a direct response to a local problem and need, and are in very restricted premises.

They have diverse origins, organisational structures, funding and service profiles. For some, it

took several years from the recognition of a need to their establishment. Finding premises and

local opposition have been common problems. There have been no recent rigorous evaluations of

their performance or effectiveness. All have however met a manifest need and all have strong

advocates and supporters.

17

Table 3.1 The origins, funding and staffing of wet centres

Centre Organisation Origins Funding Core staffing


Forge Midlands

Evening centre for male ex-offenders for 30 years. Day centre from 1994. Wet centre from July 2000.

Statutory. Leicester City Council (50%); Drug and Alcohol Action Team (50%)

Manager, 3 project workers, 2 day centre workers.


The Booth Centre

Drop-in and activity centre since 1995. Wet garden since September 2001.

Insecure and time-limited. Homelessness Directorate; The Community Fund; Central and North Manchester Primary Care Trust; charitable funding.

Manager; 2 project workers; 4 sessional activity workers; 30 volunteers (15 are clients).


Framework Housing Association

Started as a wet centre in 1991. Mostly statutory from Nottingham City Council. Time -limited funding from Homelessness Directorate.

Manager, 2 deputy managers, 12 tenancy support workers.


Equinox Started as a wet centre in September 1998.

Insecure. Brighton City Council (33%); National Lottery (33% for 3 years); Health Authority (20%); Supporting People; Drug and Alcohol Action Team, and private trusts.

Manager, assistant manager, 3.5 project workers, housing support worker, and four volunteers.


Oxford Night Shelter

Night shelter since 1982; and drop-in centre during day since 1999. Wet centre from Nov. 2001.

Mostly statutory. Oxford-shire Health Authority and Oxford City Council. Some public donations, and subsidised by night shelter.

Separate staff team for wet centre: 6 full-time and 2 part-time staff.

Tollington Way, London

Finsbury Park Street Drinkers Initiative

Started as a wet centre in January 2000

Mostly statutory. Islington, Hackney and Haringey Councils; Islington Primary Care Trust; Neighbourhood Renewal Fund; Dion Committee and the Irish Government; Islington Drug and Alcohol Action Team; charitable funding.

Manager; three project workers; two outreach and resettlement workers; front-of-house coordinator, and one volunteer.

Specialist Dependency Service, London

Bridge Housing Association

Day centre in premises since 2002. Wet centre since May 2003 when the day centre is closed.

Statutory from London Borough of Camden.

Manager; 3 project workers; 4 centre workers.

Wishart Centre, Dundee

The Wishart Centre

Started as a wet centre in 1978. Mostly statutory. Dundee City Council Social Work Department; NHS Tayside; charitable funding.

Manager, deputy manager, 8 project workers.

Sources: Compiled in August / September 2003 from information supplied by the centre managers, and written reports about the centres.

18

Table 3.2 Basic provision at the wet centres

Centre Opening times Clients Basic services

Activities Drinking rules


Wet centre: Mon-Sat 10 am-4 pm (open access 12.30-4 pm). Mon, Tues, Thurs 7-9.30 p.m. (no drinking)

Caseload of 60-70 clients. Maximum 30 in centre at a time.

Sandwiches / rolls; showers; clothing.

REMIT runs computer sessions; art group; and women’s group. Also board games; quizzes.

Amount restricted. Drink in one room and garden.


Mon-Fri 9 am-3 pm.

Drop-in sessions: Tues and Thurs am; Wed pm for over 50’s.

60-100 at drop-in sessions. No limit on numbers.

Sandwiches; cooked meal Mon., Weds. and Fri; toiletries; fruit.

Education and training courses, e.g. English and maths, first aid; computing; music; cookery; creative arts; sports; outdoor activities, e.g. walking; gardening; conservation work in parks; and weekend outdoor pursuits.

Amount not restricted. Drink in the garden.


Tues, Weds, Thurs: 9.30 am-3 pm as drop-in, and 3 pm-4.30 pm for activities Fri, Sat, Sun, Mon: 9.30am-4 pm.

Average 75 a day. Maximum 25 at a time.

Breakfast and dinner; showers; laundry.

Music workshops; day trips; computer sessions; cookery; arts and crafts.

Amount not restricted. Drink in one room.


Mon-Fri 10 am-4 pm.

Sat-Sun 10 am-2 pm.

40-55 daily. Maximum 30 at a time.

Breakfast (not week-ends); showers, laundry; clothing.

Foundation Programme for clients after detox.

Amount restricted. Drink in one room.


Wet centre: 10 am-4 pm daily.

80-110 daily. No limit on numbers.

Dinner; showers; laundry.

Art groups; football; day trips.

Amount not restricted. Drink in one room.


Mon-Thurs, 8am-3 pm Average 60 clients daily. No limit on numbers.

Dinner; showers; laundry.

Literacy Group by Islington College.

No rules


Wed-Fri, 4.30-7 pm. Sat-Sun, 10 am-12.00 and 2-4 pm

10-30 daily. Limit to staff / client ratio of 1:5.

Showers; laundry; clothing.

Arts; writing; music; football; board games; bingo; films; quizzes; outings.

No rules. Free beer (5%) given out at times.


Mon-Fri, 9 am-5 pm. Average 24 daily. No limit on numbers.

Dinner; laundry; showers; clothing.

Pool; quizzes; outings; alternative therapies, e.g. reflexology.

Amount restricted.

Drink in one room.

19

Table 3.3 Specialist services at the wet centres

Centre Health care Substance misuse Street outreach Resettlement and tenancy support


Homeless Healthcare Team. GP at centre 4 afternoons, and nurse 3 afternoons. Clients referred to CPNs in team.

GP and nurse provide ‘home detox’. Weekly session by social worker from l.a. Substance Misuse Support Team.

Outreach by Leicester City Council Outreach Team. Outreach team at centre most days.

Leicester City Council Resettlement and Tenancy Support Team.


Homeless Advocacy Project nearby, with GP and primary care nurses; Homeless Mental Health Team weekly.

Turning Point drugs worker weekly; Manchester Drugs Service outreach worker weekly; Soc. Serv. Alcohol Team Care Manager weekly.

Outreach by Contact and Assessment Team for city. Outreach team at centre most days.

Weekly visits by local authority housing departments. Centre staff undertake tenancy support, and occasional home visits.


Close link to Windmill Health Centre: GP visits weekly. Nottingham Health Team for Homeless People and Mental Health Support Team twice weekly.

Needle-exchange service twice weekly. Drug and alcohol liaison nurse from Sneinton Hermitage (alcohol treatment project) visits weekly and assesses clients.

Outreach by Contact and Assessment Team for city. Outreach team at centre most days.

Centre staff undertake resettlement and tenancy support. Home visits to clients.


GP surgery for homeless people (10 minutes walk). Mental health team visits centre weekly.

‘Addaction’ open-access clinic nearby, and worker visits wet centre weekly. Outreach nurse from substance misuse team visits weekly.

Outreach by Rough Sleepers Street Services Team. Centre staff do one session a week with the team.

House for 5 heavy drinkers (since Feb 03). Centre staff undertake tenancy support, mainly within the centre.


Physical and mental healthcare provided by Luther Street Medical Centre (next door).

Luther Street Medical Centre (next door). Has specialist addiction nurses. Provide ‘home detox’ for clients.

Outreach by the St Thomas’s CAT and Salvation Army outreach teams.

Five resettlement workers for night-shelter and wet centre. Supported housing for 60 clients (Julian Housing).


No health care service at centre. Clients referred to local GPs.

Worker from Angel Drugs Project visits weekly. Referrals to nearby North Islington Drug Service.

Centre staff do street outreach work. Joint outreach work with other agencies.

Centre staff undertake resettlement and tenancy support. Home visits to clients.


Clients referred to local GPs. Nurse and mental health support worker at main day centre Mon-Fri.

Alcohol worker at main day centre Mon-Fri.

Outreach by Crime Reductions Initia-tive team, but not work when wet centre open.

Centre staff undertake resettlement. Refer to Tenancy Sustainment Teams for tenancy support.


GP clinic twice weekly; full-time specialist nurse based at the centre; visiting podiatrist monthly. Link with local dentist. Referrals to mental health services.

Referrals made to Social work Department Drug & Alcohol Team.

Outreach by city’s Outreach and Resettlement Team.

Resettlement and tenancy support by city’s Outreach and Resettlement Team.

20

R4 The performance of four wet centres

This chapter provides information about four wet centres that were studied in depth for the

research: Tollington Way in north London, the Anchor Centre in Leicester, the Booth Centre in

Manchester, and Handel Street Centre in Nottingham. The chapter describes the centres’

facilities, staffing and funding, links with specialist agencies, and their clients. It also presents

statistical information about the work with the clients and the outcomes. The information was

gathered from interviews with the staff and sessional workers, and from the centres’ statistical

reports.


Tollington Way (formerly the Finsbury Park Street Drinkers Initiative) is open Mondays to

Thursdays from 8 a.m. to 3 p.m. It is on a residential street and occupies two terraced houses

which have been combined. The premises are rented from the council (£18,000 per annum) and

have three floors. The ground floor stretches across both houses, and has two dining rooms for

the clients, toilets and showers, and a garden. The upper two floors of just one of the houses are

used as staff offices and a kitchen. The first and second floor of the other house is rented to a man

who is at work during the day. Drinking is permitted anywhere in the centre and in the garden.

There is no limit on the amount of alcohol that can be brought into the centre.

Funding

Most of the funding for Tollington Way during 2002-03 has been from statutory agencies. It

receives a substantial grant from Islington Borough Council through ‘Supporting People’, and

smaller amounts from Hackney and Haringey councils. Islington Primary Care Trust and The

King’s Fund each fund one worker, and other funds are obtained from The Dion Committee and

the Irish Government (for 2 posts), the Neighbourhood Renewal Fund, Islington Drug and

Alcohol Action Team, and charitable funding. Until two years ago nearly all the centre’s funding

was charitable money. According to the centre manager, being in receipt of statutory funding

provides an opportunity for the staff to attend meetings with other agencies and to discuss the

clients’ needs.

Core staff and their roles

The centre has a manager, two outreach / resettlement workers, two project workers (one co-

ordinates access to substa nce misuse services, and the other access to mental health services), a

part-time project / outreach worker, a front-of-house co-ordinator, and a cook. A volunteer does

the clients’ laundry and helps serve meals.

21

Some staff are involved in front-line work and are responsible for the day-to-day running of

the centre, and engage with new attenders, build their trust and find out about their problems.

They then refer the clients who need help to other staff who are involved in individual case-work.

The team meets every Friday to discuss the progress of the clients and issues that have arisen.

The staff carry out street outreach work to meet new street drinkers and encourage them to use the

centre. They are also involved in resettling clients and provide tenancy support in their homes.

Most of the staff have worked in the fields of homelessness and substance misuse for many years,

and have been employed at the centre for more than two years.

Links to specialist agencies

Few specialist agencies provide services at Tollington Way, and there are no sessions by primary

health care or mental health teams. Weekly sessions by a nurse from the Primary Care for

Homeless People team started in 2002, but were discontinued after a short while. Clients with

health problems have to be referred to local GPs. One in particular has an interest in the client

group and will register those who are living in his catchment area. The staff liaise with Focus (a

specialist mental health team for homeless people) and with community mental health teams, but

find it difficult to get mental health assessments and services for the clients, particularly for those

who are heavy drinkers. There are also great difficulties in getting local authority social services

to carry out community care assessments for vulnerable clients.

As for substance misuse services, a worker from the Angel Drugs Project who has both

substance misuse and mental health training attends the centre weekly. Clients are also referred to

the North Islington Drug Service which offers assessments on the same day. Access to alcohol

detoxification services is a big problem, and the wait for a bed is two or three months. The centre

used to have priority rights to some detoxification beds at Rugby House, a nearby substance

misuse residential treatment facility. This arrangement was funded by Healthy Islington for six

months as a pilot project and was well-utilised, but funding was subsequently discontinued.

Joint street outreach sessions are conducted by the centre staff and other agencies, including

the Angel Drugs Project, New Roots (a black and minority ethnic group outreach service), and St

Mungo’s. The staff make use of the free legal services provided by the Mary Ward Legal Centre

in central London. It has dr op-in sessions for debt problems on Tuesdays and for housing

problems on Thursdays.

Services and activities

Beverages and dinner are provided free of charge, and the clients have access to showers and

laundry facilities. Other services include help with sorting out social security benefits, assistance

with accessing housing, health, substance misuse and legal services, and help with rehousing and

tenancy sustainment. A worker from Islington College runs a Literacy Group at the centre each

week, but there are few other activities, partly due to limited space. Some staff believe that there

should be more activities at the centre.

22

The clients

Few statistics are gathered about the clients, the help that they receive, or the outcomes. The staff

recognise this as a problem and believe that computerised records need to be kept. Between July

2002 and June 2003, 360 clients used the centre. Of these, 240 were regular users and the others

intermittent or occasional users. 65% were from the London Borough of Islington and the rest

from the Boroughs of Hackney, Haringey and Camden. Of the attenders, 30 (8%) were sleeping

rough at the time of their initial contact. Many others were in insecure, unsafe and unsupported

accommodation. Most had alcohol or drug pr oblems. During the 12 months, 25 people were

registered with local GPs, 30 were accompanied to various hospital and clinic appointments, and

30 were referred to residential drug and alcohol services. In the spring of 2003, however, there

were waits of up to 14 weeks for an alcohol assessment, and few people received treatment.

An evaluation of the centre was undertaken in early 2002 (Meldrum, 2002). It found that

87% of the clients were men, many were aged 30-49 years, and most were classified as Brit ish

(50%) or Irish (35%). Most were housed in council accommodation. 76% had a longstanding

illness or disability, and 40% were registered as disabled. 28% were not, however, registered with

a GP.

Local community relations

As described in Chapter R3, the centre experienced problems with local residents and businesses

at its former location in Blackstock Mews. It is now next door to a fish-and-chip shop, and very

close to a school and nursery school. There are also three parks in the area (Elthorne, Finsbury

and Whittington Parks) where street drinkers congregate. Some use the wet centre but others do

not. There is no ban on street drinking in the vicinity.

Since moving to its current premises in September 2001, there have been intermittent

problems with the local community. A meeting was held with local residents and businesses

when the project first opened, at which concern was expressed about the centre. Another meeting

was held in May 2003 following many complaints. These featured the behaviour of the wet

centre clients, including urinating in the street, drunk and disorderly behaviour, damage to

property (a client had fallen against a fence and broken it, and another was alleged to have thrown

a brick through a car windscreen), and that a clie nt tied up two Rottweiler dogs outside the centre

and people were worried about passing by these dogs. There have been concerns that the project

closes and the clients disperse onto the streets at the same time as the children leave the school

and the nursery.

The staff believed that the complaints were justified and have taken action to remedy the

situation. A code of conduct was drawn up with the clients: this advises that the clients use the

toilet before leaving the centre and disperse using different routes. The man who owned the dogs

stopped bringing them to the centre. Discussions are also underway to change the time that the

centre closes so that it does not coincide with the closure of the school and nursery.

23

The owner of the fish-and-chip shop alleges that he has lost trade since the centre opened,

as women and children tend to avoid his shop. He has complained to the local council. The local

police do not believe that street drinkers are a major problem in the area, and that drugs are a

bigger issue. They have little involvement with the centre and have had few complaints from the

local residents.


The Anchor Centre in Leicester is open six days a week (not Sundays) between 10 a.m. and 4

p.m., and on Monday, Tuesday and Thursday evenings from 7 p.m. to 9.30 p.m. It is spacious and

has four rooms on the ground floor for clients (including an open-access computer room), a

kitchen, toilets and showers, a back yard, and offices on the ground and first floors. There are

CCTV cameras in all rooms on the ground floor. The building used to be a factory and is leased

from the council. It was renovated in 2002 with a grant from the Community Action Against

Drugs Team. According to the staff, the environment and furnishings have much improved since

the refurbishment.

It operates both as a wet project and a day centre: the mornings (until 12.30 p.m.) are

restricted to drinkers, whereas in the afternoons and evenings it is open-access. Up to 30 clients

are allowed in the centre at any given time. One room and the back yard are designated wet areas

where alcohol can be consumed. Drinking is allowed during the day but not at the evening

sessions. The amount of alcohol brought into the centre is restricted to four cans of strong beer or

2½ litres of cider per client. They clients sign an attendance sheet when they come into the centre

and record the amount of alcohol that they have.

Funding

50% of the centre’s funding comes from Leicester City Council, and the rest from Leicester Drug

and Alcohol Action Team (DAAT). It originally received substantial but time-limited funding

from the Invest to Save Budget. Once this ceased in 2002, funding was obtained from DAAT,

which increased its responsibilities for drug users. The staff believe that this is beneficial as an

increasing number of clients misuse alcohol and drugs alternately or simultaneously.


The centre has a manager, three project workers for the wet centre, and two day-centre workers.

According to the manager, there are difficulties in recruiting experienced staff. In August 2003,

two workers had been in post less than six months, one had been a locum worker for 18 months,

and two had been employed at the centre for more than two years (one left that month). There are

no volunteers at the centre.

The three project workers have caseloads and work with individual clients, assessing their

needs, helping them to sort out problems, making referrals to other agencies, and supporting those

in tenancies. The two day centre workers are responsible for the open-access afternoon and

24

evening sessions, and do not have caseloads. They engage with clients when they attend the

centre, offer general advice, and refer those who require help to the project workers. The latter

undertake key-working sessions with individual clients. The staff do not generally undertake

street outreach work or home visits to clients in tenancies. These tasks are undertaken by other

workers (see below).


Since opening, the Anchor Centre has received a great deal of input from various agencies. Street

outreach workers employed by the City Council visit the centre several times a week – one is a

substance misuse worker. They use the centre as a venue for contacting rough sleepers, and for

meetings with clients. The Leicester Homeless Primary Health Care Service provides medical

services at the centre five days a week (GP four days, and specialist nurse practitioner three days),

and has Personal Medical Services status. It thus provides a full range of primary care services to

clients who are registered, including 24-hour medical cover, health screening, family planning,

and a community detoxification programme for some clients.

A soc ial worker from the local authority Social Services Substance Misuse Team visits the

centre weekly. He carries out community care assessments to help clients access rehabilitation

programmes and residential care, and either advises or makes onward referrals for clients who

have housing and benefit problems. It can take six to nine months to get a place for a client with

an alcohol problem into a rehabilitation programme, partly because there are no such services in

Leicester and they have to be referred elsewhere. There have been placements in Bournemouth,

Sheffield, Newcastle and Shropshire.

Some agencies do not have regular sessions at the centre but accept referrals as required.

These include Leicester City Council’s resettlement and substance misuse tenancy support team, a

specialist homeless mental health team, and a psychologist employed by the local NHS Trust.

The psychologist works directly with clients, and also provides training for the centre staff and

helps them construct clients’ care-plans. The centre staff also liaise with the Probation Service, as

many clients have a criminal history.

A multi-disciplinary team meeting is held every Tuesday at a nearby day centre, and is

attended by staff from the Anchor Centre, hostel managers, health care staff, and staff of other

agencies in Leicester that work with homeless people. The wet centre has its own team meeting

every Wednesday morning to discuss the progress of clients and issues that have arisen.


Snacks such as rolls and cereals are provided at the centre for a nominal charge. There used to be

a cooked meal at midday but there was little demand. There are showers but no laundry facilities.

The clients can launder at a day centre nearby. Other services offered to clients include help with

sorting social security benefits, assistance with finding housing, health care services, help with

tackling alcohol and drug problems, and support with sustaining tenancies.

25

With funding from the Department for Education and Skills, an external organisation,

REMIT, runs a weekly women’s group, computer sessions and a twice weekly art group at the

centre. The day centre workers organise board games and quizzes. The staff are keen to have

more activities at the centre. The clients

Between April 2002 and March 2003, 134 clients with alcohol or drug problems who are on the

caseload of a project worker used the wet centre. This count does not include clients who attend

the drop-in centre only casually. As shown in Figure R4.1, there has been a slight change in the

ages of the clients since it opened. Fewer attenders now than two years ago are over the age of

40, while more are aged 26-40 years. The number of very young clients (18-25 years) has also

fallen. In 2002/03, 23% of the clients were women and just 11% from minority ethnic groups.

38% were in tenancies, 18% were in hostels, and most others were classified as ‘no fixed abode’.

Only one person was currently sleeping rough, although 32 clients had slept rough at some time

during the previous 12 months.

Figure R4.1 Ages of the clients, Anchor Centre, Leicester

Age groups (years)

56+41-5526-4018-25

Num

ber

of c

lient

s

60

50

40

30

20

10

0

Year

2000/02

2002/036

21

57

16

9

28

44

19

Among the 134 wet centre caseload clients, 39% had alcohol dependency problems, 37% drug

problems, and 24% were dependent on both alcohol and drugs. Among the 81 drug users, heroin

was the most common drug used (67%) although many alternated with crack and some with

alcohol. Drug problems were characteristic of the younger clients, while alcohol dependency was

the main problem for the older age groups. Those aged 26-40 years were the group most likely to

be polyusers (Figure R4.2).

26

Figure R4.2 Substance dependency problems by age

Age group (years)

55+41-5526-4018-25

Num

ber

of p

eopl

e

80

60

40

20

0

Dependency

drugs

drink & drugs

drink

28

185

25

8

2024

Performance and outcomes

At the Anchor Centre, performance and outcome targets were set for the year 2002/03 which

included: (i) providing case-work to 60 clients, of whom 30 were to be drug users; (ii) improving

the health and well-being of 17 service users and thereby making an impact on their life

expectancies; (iii) ensuring that 60% of service users reduce their alcohol consumption and 60%

control or reduce their drug use; (iv) enabling 15 service users to retain their tenancy or achieve

housing stability for at least three months; (v) assisting 40 service users with rent arrears; and (vi)

directing 75 users to housing services, and 85 to other statutory and voluntary services.

Information about the situation of clients who use alcohol or drugs is monitored by the staff

in two ways: through observations by the staff and details gathered during assessment and ke y-

working sessions, and through the use of Christo Inventory for Substance Misuse Services forms

which are completed every three months by the key-workers and record information about the

client in the previous month. Topics covered include: general health, social functioning, drug and

alcohol use, criminal involvement, psychological state, support recieved, and compliance with

services. The form is only completed with people who currently attend the centre, and therefore

does not identify the number of people who have been helped and have stopped attending.

From April 2002 to March 2003, the centre worked with 53 alcohol dependent clients, 49

drug users, and 32 people who had both alcohol and drug problems. Information was available

about the drinking habits of 76 clients. As shown in Table R4.1, there was no change for one-

quarter of the clients, seven-tenths had periods of reduction or abstinence, and only a minority

appeared to have increased their alcohol consumption. Nearly one-quarter accessed alcohol

services, ten clients attended detoxification programmes although only one has remained

27

abstinent, and three were accepted for a residential rehabilitation programme. Of the latter, one

died before entry, one failed on the first day, and one did not attend although she has remained

abstinent. 45% of the clients still drank on the streets at times, mostly when the centre was

closed, during hot weather, or if they had been barred from the centre.

Table R4.1 Drinking habits and access to alcohol treatment services, 2002/03

Characteristic Number %

Drinking habit:

periods of abstinence 12 16 periods of reduction 41 54 no change 20 26 increased drinking 3 4 Treatment: uses alcohol services 18 24 detoxification service 10 13 Number of clients 76

Table R4.2 Service referrals by Anchor Centre workers, 2002/03

Agency Number

Emergency accommodation 36

Other hostels 35 Outreach services 49 Housing Options 40 Local authority substance misuse support team 20 Other support teams 11 Alcohol services 7 Drug services 9

The number of clients referred to other services during the 12 months ending March 2003 is

shown in Table R4.2. This relates only to referrals made by the wet centre staff and does not

include those made by other local agencies. Many clients were referred to housing and tenancy

support services, while direct referrals to substance misuse services were few. The latter are often

made, however, by the healthcare team or by hostels or support services once a client is engaged.

During 2002/03, 24 clients were resettled. There were also 16 failed tenancies, nine within

12 months. Reasons for tenancy failures included rent arrears and eviction or abandonment,

eviction for anti-social behaviour, and loss of tenancy when taken into custody. Some clients were

28

not ready for resettlement, some required high support accommodation, and several failed to

engage with their support workers.


The Anchor Centre is in a side street near the city centre, next door to a theatre, and opposite a

block of flats owned by a housing association. In front of the flats is an area of grass where the

clients sometimes sit. There is a public house opposite and another at the end of the street. The

city centre has a ban on street drinking in public places, and the restriction area includes the

Anchor Centre. At times, the local police and community safety officers move people on when

they congregate on the grass opposite the centre, but they return after a while. According to the

outreach workers, most street drinkers use the wet centre.

There have been several complaints from local residents and the theatre about the behaviour

of the clients and about loitering on the grass (which local residents find intimidating), and empty

beer cans and bottles left on the street. The staff do not believe that all the complaints are

justified, as some discarded cans and bottles are for types of alcohol that the clients do not drink.

Nevertheless the staff have responded to the problems. The centre’s closing time previously

coincided with the opening of the theatre and has been changed, and the council gave funds to the

theatre to install CCTV cameras and shutters outside (drinkers used to sit on some entrance steps).

The street cleansing team now clean the area around the centre twice weekly instead of once a

week, and the centre staff clean up if, for example, a client urinates on the theatre steps. Meetings

every three months are held with the local housing manager, a representative from the tenants’

association, the theatre manager, the city council and the wet centre manager, but some local

people feel that not enough is being done.


The Booth Centre in Manchester is open Monday to Friday between 9 a.m. and 3 p.m. On

Tuesday and Thursday mornings drop-in sessions are held and the wet garden is open from 9 a.m.

to 12.30 p.m. There are also drop-in sessions for people aged 50+ years on Wednesday

afternoons. During the rest of the week, there are group activities which anyone is welcome to

attend. The centre is small, has just one room for the clients with a small kitchen area, a toilet, an

office, and an adjacent wet garden. It is bright and has numerous photographs around the walls of

clients engaged in activities. Manchester Cathedral owns the building, does not charge rent, and

pays for the utilities.

Alcohol is not permitted in the centre but can be consumed in the garden during the Tuesday

and Thursday drop-in sessions. The garden was set up to safeguard and extend the centre’s work

with street drinkers (see Chapter R3), and is a supervised setting where people can drink and

receive support, advice and encouragement to engage in activities so as to reduce their drinking

and improve their health. Staff are always in the garden when it is open. There is no restriction

on the amount of alcohol brought into the garden, but no glass bottles are allowed.

29

Funding

The centre receives funding from the Homelessness Directorate (through Manchester City

Council), The Community Fund, Central Manchester Primary Care Trust, and various charities.

The North Manchester Primary Care Trust funds a worker for the wet garden. The various

funding sources are time-limited and there are difficulties in securing money.


The centre has a manager, two project workers, four sessional activity workers e.g. art teacher and

photographer, and about 30 volunteers. One-half of the volunteers are clients who are

participating in a Supported Volunteering Project (described below). They work at the centre one

session a week, but not at the drop-in sessions. One of the project workers is a move-on activities

worker and is responsible for helping the clients to access education, training and work schemes.

The other is a volunteer co-ordinator and is responsible for the recruitment, induction, training and

supervision of the volunteers. There is a low turnover of paid workers and volunteers.

Using volunteers is not a cheap option as it takes time and resources to provide the

support, training and supervision that they need. The staff believe, however, that volunteers have

an important role at the centre which cannot be provided by paid workers. The clients are aware

that the volunteers choose to help them and are not paid, and during the drop-in sessions the

clients have someone to engage in general conversation and to talk to about how they are feeling.

This can increase self -esteem and motivation, and reduce friction and aggression. It also helps to

create an environment where the views and contributions of users are valued.


According to the centre manager, it took a long time to involve specialist agencie s at the Booth

Centre, but now several provide input, particularly during the drop-in sessions. There are weekly

visits by a community psychiatric nurse from the Homeless Mental Health Team, and a health

linkworker from the Homeless Advocacy Project. The latter is a member of the primary health

care team based at a nearby GP surgery for homeless people, and the linkworker’s role is to

encourage clients to register with the GP and to keep appointments with health and allied workers.

The nurses sometimes use the Booth Centre as a facility where they can contact clients and, for

example, administer treatments.

A social services care manager from the local authority drug and alcohol team visits each

Tuesday. His role is to undertake community care assessments for clients who wish to access

alcohol rehabilitation services, and to assess the needs of those who have tenancies and arrange

for services such as home care, meals -on-wheels, aids and adaptations, and tenancy support

workers. There are weekly visits by a drugs worker from Turning Point, and by a worker from

Manchester Drugs Service Team who can arrange methadone scripts. Arrangements are also in

place with Turning Point for clients to be admitted to its alcohol detoxification beds.

30

The street outreach team, Counted In, visits the centre most days to make contact with rough

sleepers. Specialist drug, alcohol and mental health workers are in the team. Two staff from the

local authority housing department also have weekly sessions at the centre. The staff attend Case

Intervention Group meetings as part of the Crime and Disorder Strategy.


The Booth Centre provides a free cooked meal on Mondays, Wednesdays and Fridays for clients

who have attended the morning activities, and beverages and sandwiches at other times. Fresh

fruit is given out daily, and toiletries and socks are provided. There are no showers, but there is a

day centre at Salford Roman Catholic Cathedral (about 15 minutes walk away) where the clients

can have showers. Advice and help is given with sorting out social security benefits, accessing

housing, health and other services, tackling alcohol and drug problems, and with sustaining

tenancies. Home visits are occasionally carried out by the staff, but most of the tenancy support

work takes place at the centre. In September 2002, an Internet cafe was started in the centre, and

clients use it to register online for council housing and to keep in contact with family and friends.

The Booth Centre has a strong focus on indoor and outdoor activities that are creative,

therapeutic, challenging and enjoyable. The aims are to empower people to make informed

choices, to provide them with positive experiences to help build self-respect and self -confidence,

to enable them to structure their time positively and work together in groups, and to provide an

alternative to drinking on the streets or alone in a tenancy. The long-term aim is to get the clients

involved in education, training, employment, volunteer work or other activities outside the centre.

The staff find that the clients use the activities as a way of controlling their alcohol intake: they

are occupied and tired by physical exertion and delay drinking until late in the day when the

activities finish.

The centre runs 10 week ‘activity courses’ which conclude with a presentation session at

which the clients are awarded certificates for their achievements. Each client has a ‘course work’

folder or portfolio, which contains their certificates and other work. The activities are selected by

the clients and include: art, computer courses, English and mathematics classes, cookery,

carpentry, music, swimming, badminton, photography, pottery, bowling, golf, walking, canoeing,

pony trekking, tending the wet garden and the centre’s two allotments, and conservation work in

parks and forests. Among the street drinkers, the most popular activities are art, English and

maths classes, fishing, gardening and decorating.

A Supported Volunteering Project has been in operation since 2001, whereby clients work as

volunteers at the centre one session a week. This enables them to experience volunteering in a

safe environment, and to gain confidence and new skills. They receive induction training, and

attend team-building weekends with the staff and various in-house courses, such as food hygiene,

health and safety, first aid, and customer care. Clients are also helped to move on to education,

31

training and voluntary work in the community, and four part-time jobs have been created by the

Cathedral which provide a first step into employment for people who have not worked for years.

The clients

Between April 2002 and March 2003, 176 people attended activity sessions at the Booth Centre,

and each week 120 people used the drop-in sessions and 50 used the wet garden. Most clients

were men (92%), 23% were rough sleepers, 19% lived in hostels or squats, and 47% had

tenancies. Most were aged 26-35 years (33%) or 36-55 years (43%). Just 9% were aged 25 years

or under, and 15% aged 55 years or over. Most had alcohol or drug problems, and several also

had mental health problems. Some alternate between drugs and drink when they are trying to

reduce their drug use or are unable to afford drugs. 37% of the activity attenders were street

drinkers.

Between April to June 2003, 72 clients attended activity sessions at the centre. Of these,

35% were rough sleepers and 58% were street drinkers. Among those who worked as volunteers

at the Booth Centre during this period, seven were street drinkers.

Performance and outcomes

Information is recorded about the work that is carried out with clients and the activities in which

they participate, and quarterly reports are prepared of performance and outcomes. In addition,

monitoring sheets record the type of help or advice that is given by staff each day to vulnerable

clients who have tenancies. Table R4.3 shows the number of clients that were linked into

housing, health care and other services over two periods: April 2002 to March 2003, and April to

June 2003. During the 12 months ending March 2003, 452 activity sessions were held for the

clients.

Table R4.3 Help given to the clients at Booth Centre, 2002-03

Help given 12 months 1 3 months 2

Number Number

People moved into temporary accommodation 52 4

People moved to permanent / supported accommodation 20 26

Rough sleepers referred to outreach team 49 11 New GP registrations 59 15

Newly referred to other health services 49 6

Birth certificates obtained 72 13 Referred for alcohol detox 22 9

Participated in Supported Volunteering Programme 23 12

Started education, training, employment or voluntary work 21 7

Notes: 1. April 2002 to March 2003. 2. April to June 2003.

32


The shopping centre in central Manchester is one of the largest in the country, and the inter-mixed

financial, commercial, professional and governmental offices are also an important element of the

city’s economy. Street drinking and anti-social behaviour have been problems in the past. The

reconstruction of the northern end of Market Street following the devastating 1996 IRA bomb was

co-ordinated by a ‘City Centre Task Force’, and the redesign included the largest Marks and

Spencers in the world and a new Shambles Square with the Tudor-style wood frame Wellington

Inn is 100 yards away from the Cathedral (see www.manchester2002-

uk.com/buildings/bombing.html).

The Booth Centre is accommodated in an annex of Manchester Cathedral and is surrounded

by grass banks. The cathedral is a tourist attraction and particularly during the summer, many

people sit on the grass banks. Street behaviour which intimidates or upsets shoppers and tourists

and could lead to the decreased attractiveness of the rebuilt shopping areas close to the Cathedral

therefore produces quick censorious reactions. There has been a ban on street drinking in the city

centre since 1998 when byelaws were introduced, and the area around Manchester Cathedral is

included in the ban. Even before the reconstruction the police established a Homeless and

Begging Unit in 1995 to tackle the large number of beggars in the city centre.

According to the outreach workers, the street drinking ban has dispersed many street drinkers

beyond the cit y centre where the ban ends, and there are now two clusters of street drinkers. One

group congregates to the north around Manchester Cathedral and Victoria Station and they tend to

use the Booth Centre. The other to the south is around Oxford Road and they do not use the

Booth Centre. According to the police and the outreach workers, many drinkers linger on the

grass banks around Manchester Cathedral and the Booth Centre, and some sleep there at night.

The problem worsened since an off-licence opened in the area, and there have been complaints of

intimidation and violence from local businesses and other people. A hotel facing the Cathedral

has alleged that the problem is affecting their business. The centre staff work closely with the

police, the street wardens, local businesses and the Cathedral managers to address the problem,

which is not entirely associated with the centre users. The police believe however that the centre

is too close to the shopping centre and to the cathedral.


The Handel Street Centre in Nottingham is part of Framework Housing Association’s Handel

Street Alcohol Support Project and Albion Supported Housing scheme (HASP/ASH). The project

comprises the wet centre at Handel Street, Sneinton Hermita ge (a ten-bed alcohol treatment

project for people who want to control or reduce their drinking), and seven shared houses which

accommodate 17 people with alcohol, drugs or mental health problems.

The wet centre is open seven days a week. On Mondays, Fridays, Saturdays and Sundays

it is open from 9.30 a.m. to 4 p.m.; and on Tuesdays, Wednesdays and Thursdays from 9.30 a.m.

33

to 3 p.m. there are drop-in sessions, and from 3 p.m. to 4.30 p.m. activity sessions. The centre is

small and on just the ground floor. It has a day room with adjoining kitchen, a wet room, unisex

showers and toilets, a small staff office at the front of the building with adjoining laundry

facilities, and two rooms which are used as a clinic by the medical team and at other times as

offices. Entry to the centre is electronically monitored and controlled from the staff office. The

wet room was a meat store for the market and is dismal. It has benches around three walls,

windows high up on one wall, and a drain grid in the centre of the room. The building is owned

by the council. The staff acknowledge that it is not ideal and is too small, and new premises are

being sought.

Up to 25 clients are allowed in the centre at any given time. Alcohol can only be

consumed in the wet room, and there is no restriction on the amount that can be brought into the

centre. The centre targets people with alcohol problems and rough sleepers with substance misuse

problems, and refers other attenders to alternative services. New clients are assessed by the

manager of Sneinton Hermitage (an alcohol and drug liaison nurse) to determine the extent of

their substance misuse problem.

Funding

The centre’s funding is mainly from the City Council. Some time-limited funding has been

obtained from the Homelessness Directorate. The centre staff also undertake tenancy support for

35-40 clients, and so receive funding from ‘Supporting People’.


The core staff team are a manager, two deputy managers, 12 supported housing workers, 1.5

cooks, and 1.5 cleaners. According to the manager, there was a high turnover of staff until about

three years ago. Tenancy support services were then introduced, whereby the staff work three

days a week at the wet centre and two days supporting clie nts in their tenancies. This meant that

the staff team has increased, and therefore the number of weekends that staff have to work has

reduced. In the past, the centre had occasionally to close when there was not enough staff to

cover holidays and sickness. One-half of the current staff team are former volunteers at the

centre.

Most staff are involved in both day centre and tenancy support work. There is no

keyworking system in operation for the wet centre users, but the staff assess the needs of new

clients and make referrals accordingly. They also have a caseload of tenancy support clients some

of whom are former users. The staff are encouraged to develop skills in one aspect of the day

centre work, such as welfare rights or mental health issues. One worker is the activities co-

ordinator and does not do tenancy support. Street outreach work is carried out by the city’s

Contact and Assessment Team and not by the wet centre staff. Both the outreach team and the

wet centre staff are involved in resettling the clients.

34


Three nurses from the Nottingham Health Team for Homeless People have drop-in clinics at the

wet centre on Mondays and Thursdays, and a needle -exchange service is run by The Health Shop

(Primary Care Trus t) twice weekly. The Mental Health Support Team run sessions twice weekly

at the centre, and for the past six months a GP has held a surgery at the centre on Mondays and

provides methadone treatment for drug users. When the patients are assessed, treatme nt has

begun, and confidence is established, they are encouraged to attend the nearby Windmill Health

Centre. The street outreach team visits Handel Street several times a week to make contact with

rough sleepers.

The centre has close links with Sneinton Hermitage (described earlier) and is thus able to

offer prompt treatment for alcohol and drug problems. One bed at the project is reserved for

people who enter detoxification, while the other nine are for those who want to abstain, control or

reduce their drinking. The manager of Sneinton Hermitage visits the wet centre weekly to assess

the needs of new clients, and to offer help to all users. Clients requesting detoxification can be

admitted to Sneinton Hermitage within two to three weeks, and the proje ct staff also undertake

home detoxification with some people. Approximately four-fifths of people admitted to Sneinton

Hermitage have had links with the wet centre. In the near future, the manager of Sneinton

Hermitage will be running a clinic at the wet centre to administer Pabrinex. Pabrinex is

concentrated Vitamin B1 (thiamine) which is given to heavy drinkers, particularly during

withdrawal from alcohol, to prevent Wernicke Korsakoff Syndrome (brain damage caused by lack

of thiamine).


A free breakfast and dinner are provided, and the clients have access to showers, clothing and

laundry facilities. Other services offered to clients include help with sorting out social security

benefits, assistance to access health and other services, help with tackling alcohol and drug

problems, resettlement and tenancy support.

Various activities for the clients are arranged by the staff, including a weekly cookery

class with a certificate on completion, canal-side walks, and trips to the museums, ice skating

rink, and bowling alley. Other activities have included arts and crafts, canoeing, abseiling, and a

10-week course on playing drums. The staff find that the clients are more relaxed and prepared to

talk when they are on excursions.

The clients

Very few statistics are recorded about the clients, the help that they receive at the wet centre, or

the outcomes. In 2002/03, the target was that 700 clients would use the wet centre. The actual

number of attenders during this period was 823. Of these, 379 had slept rough at some time.

During the year, 122 alcohol and drug assessments were carried out by the manager of Sneinton

Hermitage with the clients, 163 resettlement interviews were undertaken with them, and 252

35

clients attended educational and social sessions (36 were held during the year). Four clients

received certificates at the end of their cooking course. Little other information is currently

available, but the staff are in the process of setting up a database to record details of the clients.


The Handel Street Centre is about 10-15 minutes walk from the city centre in a former retail

market area and surrounded by car-parks, business premises and warehouses. Three hostels and

the Emmanuel Day Centre for homeless people are nearby, but there are few local residents. One

public house opposite the centre is boarded up, but another trades further down the street. There

is a ban on street drinking in the city centre and the wet centre is on the edge of the zone. Most

street drinkers in the city use the centre.

There have been relatively few complaints from local people or the market management

about the wet centre, and the police have very little contact with it. According to some workers

who have been involved with the centre for some time, there were complaints in the early days but

these have declined. Just one local property freeholder still voices concern. The police (and the

local media) are now more preoccupied with begging in the city centre than street drinking. Summary

There are similarities and differences among the four wet centres described in this chapter. The

services that they provide and their rules around the use of alcohol at the projects differ, as do

their staffing arrangements and funding. At the London and Leicester centres, some staff are

involved in front-line work and the day-to-day running of the project, while others are engaged in

case-work. In Nottingham, the staff undertake both of these roles and tenancy support, while in

Manchester volunteers play a key role. Most centres work closely with specialist agencies that

provide sessional services, and all recognise the importance of these inputs. Apart from the

London centre where staff do street outreach work, the others rely on established street outreach

teams for referrals of new clients.

One common feature is the mixed profile of the client group. They all work with a large

number of street drinkers and other needy groups, such as drug users, ex-offenders and sex-

workers. The majority of the clients are men aged in their thirties and forties. The work that is

carried out with them varies. The Anchor Centre provides a large amount of casework, while at

the Booth Centre much of the work focuses around activities. The record-keeping and monitoring

of the help that is given also varies, and not all centres can easily demonstrate their achievements

with clients. Although the centres have been running for some time, most still experience

intermittent problems with the local community.

36

R5 Wet centre clients

Face-to-face interviews with semi-structured questionnaires were conducted with 101 wet centre

clients. Of these, 26 were at the Anchor Centre in Leicester, and 25 each at the Booth Centre in

Manchester, Handel Street Centre in Nottingham, and Tollington Way in north London. This

chapter summarises the subjects’ problems, the help that they have received, and their opinions of

wet centres. There are differences by centre at which the subjects were interviewed, but there

should be caution in their interpretation. The clients were selected for interview using

convenience samples, i.e. they attended the centre during the period when the research was

conducted, and they agreed to be interviewed. Clients who use the centres only occasionally are

less likely to be represented. In addition, only a small number of attenders at each centre were

interviewed, and the information has been provided only by the clients and not corroborated by

the staff. Some clients with serious alcohol and mental health problems, for example, may not

recognise problems or recollect the help that they have received.

The subjects’ characteristics

The majority of interviewees were with men (86). Attempts were made to include women

wherever possible, and 15 were interviewed. Among the 101 participants, 62% were aged in their

thirties or forties, 20% were in their fifties, 13% were aged under 30 years and just 5% aged 60

years or over. There were age differences among the centres (Figure R5.1). The London

interviewees tended to be older (72% were aged 40+ years and none were less than 30). In

comparison, just 38% of those interviewed at the Leicester centre were aged 40+ years, and

almost one-third were less than 30. This reflects however the overall age profile of the users at

the two centres.

As to ethnic group, 60% of the clients were English, 12% were Scottish, and 3% were Welsh.

11% were Irish and 14% were from other minority ethnic groups. A slightly lower proportion

(48%) of the London subjects were English and a slightly higher proportion were Irish (16%), but

there were no other clear differences.

Current accommodation

The clients’ housing circumstances varied. At the time of interview, 34% were sleeping rough,

17% were in a hostel or night-shelter, 9% were staying with friends, and 40% had their own

tenancy. The older clients were more likely than the younger to have a tenancy. 71% of those

aged over 50 years were housed compared to 15% of those less than 30 years of age. One-half of

those aged in their forties were sleeping rough, while those aged in the twenties were most likely

to be staying in hostels (Figure R5.2). Other studies have noted that a high proportion of older

attenders at homeless people’s day centres have a tenancy (Crane and Warnes, 2001).

37

Figure R5.1 Age groups of attenders by wet centre

Wet centre location

Anchor Centre

Booth Centre

Tollington Way

Handel St

Per

cent

age

of p

eopl

e

100

80

60

40

20

0

Ages (years)

50+

40-49

30-39

< 30

19283616

19

28

36

44

31

36

28

28

31

812

Figure R5.2 Type of accommodation of attenders by age group

Ages (years)

50+40-4930-39up to 29

Per

cent

age

of p

eopl

e

100

80

60

40

20

0

Accommodation

with friends

sleeping rough

hostel

own tenancy

13232150

32

23

22

1338

71

25

42

15

The subjects’ housing circumstances differed at the four centres. One-half in London and

Manchester were in permanent accommodation, reflecting the overall profile of the users at these

two centres. In comparison, just under one-third at the other centres had their own tenancy

(Figure R5.3). Nearly one-half of those in Leicester claimed to be sleeping rough, compared to

38

one-third in Nottingham and London, and one-quarter in Manchester. (According to the manager

of the Anchor Centre in Leicester, some clients claim to be rough sleepers although they are

staying with friends). Several in Nottingham and a few in London were staying with friends.

Very few at Tollington Way were staying in hostels, which probably reflects the lack of hostel

provision in this inner-suburban London area.

Figure R5.3 Type of accommodation by wet centre

Wet centre location

Anchor Centre

Booth Centre

Tollington Way

Handel St.

Per

cent

age

of p

eopl

e

100

80

60

40

20

0

Accommodation

with friends

sleeping rough

hostel

own tenancy

13164624

3332

23

16

20

27

5650

32

The reasons why a higher proportion of clients at the centres in London and Manchester are

housed are unclear. Tollington Way in north London was established to work with local street

drinkers, and many of this group are not homeless. The centre is about four miles from central

London where rough sleepers congregate and there are many hostels and day centres for homeless

people. Many heavy drinkers in central London would find it too far to walk to Tollington Way,

and fares on public transport are high (particularly for those of working age). The Booth Centre

in Manchester has many activity sessions, and it may be that clients who are motivated to

participate in activities are also more likely to be resettled and to sustain tenancies.

There may also be a connection between resettlement, tenancy support and the use of wet

centres (or other day centres for homeless people). At the Booth Centre, 26 clients were rehoused

between April and June 2003. The staff at Booth Centre do not normally provide tenancy support

to clients at home, so some may have continued to use the centre for support. On the other hand,

the staff at Handel Street in Nottingham work with many housed clients through their tenancy

support service at home: only one-third of the interviewees at the centre were in permanent

accommodation. It may be that if support is provided at home to resettled clients it reduces their

need to attend day centres. This would require further investigation.

39

Histories of homelessness

Nearly all the subjects (97%) had been homeless at some time, and many had long histories of

homelessness. 40% had been homeless for more than five years, including 26% for more than ten

years. The distribution of homeless durations differed greatly by centre (Figure R5.4). Nearly

one-half of the interviewees in London had been homeless for less than one year, and only a small

minority had been homeless for more than 10 years. In contrast, only a few in Nottingham and

Leicester had short histories of homelessness, while two-fifths of those in Nottingham and

Manchester had been homeless for more than 10 years.

The reasons for the differences are unclear. As mentioned in the previous section,

Tollington Way in London is away from the ‘homeless circuit’ and may not be attracting

entrenched homeless people. The variations may also reflect the effectiveness of services in a city

in quickly identifying and helping homeless people. Housing factors may also be an important

element, with housing opportunities for homeless people being more available in Leicester than in

Nottingham and Manchester.

Figure R5.4 Duration of homelessness by wet centre

Wet centre location

Anchor Centre

Booth Centre

Tollington Way

Handel St

Per

cent

age

of p

eopl

e

100

80

60

40

20

0

Years homeless

> 10

> 5-10

> 1-5

up to 1

204138

20

9

20

40

18

30

46

20

32

45

13

Health and substance misuse problems and treatment

Physical health problems

Among the 101 interviewees, 90% reported one or more physic al health problems. Two-fifths

rated their health as poor, and a similar proportion reported being very worried about their health.

Respiratory and gastric problems were common, as were seizures due to alcohol use, and

40

numbness and trembling in the arms and legs (Table R5.1). One-half associated their illnesses

with heavy drinking. Those in the younger age groups were just as likely as the older subjects to

report physical health problems.

81% of the subjects were registered with a GP, and most had seen their GP within the

previous six months. 19% were unregistered (varying from 28% in London to 8% in

Nottingham). One reason for the difference is likely to be the lack of input from primary health

care services at Tollington Way. Most subjects who did not have a GP had not tried to register.

Many of this group used hospital A&E departments for medical care.

Table R5.1 Self-reports of physical health problems

Problem %

Breathing / respiratory problems 54

Heart / circulation problems 32

Gastric problems 47

Numbness / trembling in arms / legs 63

Liver / kidney problems 25

Epilepsy 6

Seizures due to alcohol (not epilepsy) 44

Other health problems 50

Number of subjects 101

Mental health problems

A high proportion (84%) of the subjects reported being depressed and low in mood. In addition,

one-half described other mental health problems including a psychotic illness (10%) and anxiety

and panic attacks (22%). Only one-quarter said that they were having treatment for their

problems, mainly through their GP. Just 8% said that they were receiving treatment for mental

health problems at a psychiatric clinic or through a specialist mental health team.

Use of alcohol

At the time of interview, 85% of the subjects reported that they currently drank alcohol and 93%

admitted to drinking during the past 12 months. Hence, a few were in respite when they were

interviewed. 62% said that they had drank alcohol most days in the previous 12 months, 5% had

drank heavily two or three times each week, and 12% had been binge drinkers with periods of

heavy drinking and abstinence. The older interviewees were most likely to report drinking most

days: this applied to 38% aged in their twenties compared to 72% aged over 50 years (Figure

R5.5). Similar differences between age and heavy drinking among homeless people have been

reported elsewhere (Crane and Warnes, 2001).

41

Figure R5.5 Heavy drinking1 and illegal drug use by age groups

Age groups (years)

50+40-4930-39up to 29

Per

cent

age

in g

roup

100

80

60

40

20

0

Problem

heavy drinker

illegal drug use

Note: 1. Drinks most days.

One-third admitted to being very worried about their alcohol consumption, and almost three-fifths

said that they sometimes spent money on alcohol instead of buying food and paying bills. For

many, alcohol had had a negative impact on their lives. It has caused or contributed to marital and

relationship breakdowns, loss of tenancies and jobs, affected relationships with children and other

relatives, and resulted in loss of self-esteem, motivation and confidence (Table R5.2). More than

two-fifths had been arrested by the police during the previous 12 months for offences related to

alcohol.

Table R5.2 Problems caused through heavy drinking

Problem %

Loss of a tenancy1 39

Problems at work / loss of a job 40

Marital / relationship breakdown 54

Affected relationship with children / other relatives 49

Ill-health 50

Loss of self-esteem, confidence and motivation 35

Arrested by police in last 12 months2 42

Number of subjects 101

Notes: 1. Through rent arrears, disturbing neighbours, or an inability to cope. 2. For drunk and disorderly conduct (25%), or for shoplifting (12%).

42

The majority of the interviewees (77%) continued to drink alcohol on the streets and in parks,

with 55% drinking outside most days, and 7% said they drank in public places at least twice a

week. Most in Nottingham reported drinking on the streets (92%), compared to 84% in

Manchester, 68% in London, and just 58% in Leicester. One-half had been drinking outside for

more than five years, and for some the habit dated back more than ten years. Only a small

proportion (12%) drank alone; most congregated in small groups with other drinkers. In London,

however, one-quarter said that they drank alone in public places.

Just over one-third (36%) said that they had received help from the wet centre staff or from

other agencies with their alcohol problems but there was considerable variation: from 60% in

Nottingham, to 48% in Manchester, and just 20% in Leicester and London. 15% had been in a

detoxification unit and a similar proportion had received individual counselling or group therapy.

The figures have to be treated cautiously as many clients who are referred to alcohol services are

unlikely to continue to attend the wet centres. Those seeking to abstain or reduce their drinking

are more likely to succeed if they break away from the street drinking culture and from their peers

at wet centres.

Use of illegal drugs

Three-fifths of the subjects used illegal drugs, and 31% were poly-drug users. The use of illegal

drugs declined with age (as reported in other studies, see Crane and Warnes, 2001). 92% aged in

their twenties took drugs, compared to 84% aged 30-39 years, 47% aged 40-49, and 24% aged

50+ years (Figure R5.5). One-fifth were receiving help from a specialist drugs agency.

Dual problems and differences in problems by centres

Many subjects had combined mental health and alcohol problems (38%), or combined drug and

alcohol problems (46%). Almost one-quarter had all three problems. There were age differences

(Table R5.3). Similar proportions in all age groups had both mental health and alcohol problems,

but the younger subjects and particularly those aged 30-39 years had the highest prevalence (74%)

of combined drug and alcohol problems. Nearly two-fifths of those below the age of 30 years, but

only 8% over the age of 50, had all three problems.

Table R5.3 Health and substance misuse problems by age groups (%)

Problem Age group (years) Total

Up to 29 30-39 40-49 50+

Mental health & alcohol1 38 39 41 32 38

Drugs & alcohol1 54 74 38 20 45

Mental, alcohol1 & drugs 38 32 19 8 26

Number of subjects 13 31 32 25 101

Notes: 1. Drinks most days, or heavily two or three times a week, or binge drinks.

43

The subjects’ problems are different at the four centres (Table R5.4). Alcohol, mental health and

drug problems were most prevalent among the Nottingham interviewees, and they also had the

highest occurrence of dual and triple problems. Nearly one-half had combined alcohol, mental

health and drug problems. In contrast, most subjects interviewed in Manchester had alcohol

problems, but they were the group least likely to have mental health or drug problems, and only a

small proportion had dual mental health and alcohol problems.

Fewer in Leicester and London reported alcohol problems compared to the other two cities,

although many without a drink problem used drugs. In Leicester, this reflects the changing nature

of the Anchor Centre with its increased responsibility since 2002 to provide a service to drug

users (see chapter R4). The reason for the low prevalence in London is less evident. It suggests

that the centre may be a resource for local people with any substance misuse problem.

Table R5.4 Health and substance misuse problems by wet centre (%)

Problem Handel St. Tollington Way

Booth Centre

Anchor Centre

Total

Physical health 96 84 88 92 90

Mental health 78 32 16 50 43

Alcohol1 100 67 96 58 79

Drugs 71 60 44 61 58

Mental health & alcohol1 72 24 12 42 38

Drugs & alcohol1 68 40 44 35 46

Mental, alcohol1 & drugs 48 16 4 23 23

Arrested by police2 64 22 52 31 42


Notes: 1. Drinks most days, or heavily two or three times a week, or binge drinks. 2. In last 12 months for offences related to alcohol (drunk and disorderly conduct, or shoplifting).

The Nottingham and Manchester interviewees were most likely to have been arrested by the

police for alcohol-related offences in the previous 12 months (Table R5.4). Both these groups

reported the highest prevalence of alcohol problems. It may also indicate police activity in the

area and the extent to which street drinking is curbed. Daily living activities

Two-thirds of the subjects mentioned that they are in contact with at least one relative or family

member, but only one-third sees the person at least once a month. Those who were housed were

more likely to report family contact than those who were homeless (43% compared to 30%

respectively).

44

Most subjects (88%) were receiving social security benefits. Among those who were not,

two were waiting for their benefits to be sorted out while eight said that they could not be

bothered to claim. Difficulties with budgeting were common. 72% said that they had problems

‘most of the time’ with managing their personal income, and 16% ‘occasionally’ had difficulties.

Just 12% reported no budgeting problems. One-fifth received help with budgeting, from friends,

relatives or workers. Those in Nottingham were most likely to receive help – this may reflect the

dedicated tenancy support work that is carried out with clients (Table R5.5).

The subjects’ eating habits varied. Many (36%) described their appetite as ‘poor’, and only

46% had a cooked meal most days. 27% ate a meal only once a week or less. Those in

Manchester were least likely regularly to have a cooked meal.

Table R5.5 Daily living tasks, all subjects (%)

Tasks and help Handel St. Tollington Way

Booth Centre

Anchor Centre

Total

Problems with budgeting:

most of the time 76 68 76 69 72

occasionally 20 16 12 15 16

Receives help with budgeting1 40 16 8 15 20

Rates appetite as poor 52 20 36 35 36

Has meal less than twice a week 32 8 48 19 27


Notes: 1. From friends, relatives or workers.

Table R5.6 Daily living tasks, permanently housed subjects (number)

Tasks and help Handel St. Tollington Way

Booth Centre

Anchor Centre

Total

Difficulty with household tasks1 5 6 2 4 17

Problems with bills 4 7 9 1 21

Has rent arrears / other debts 3 7 5 2 17

Reported at least one problem 7 12 11 5 35

Receives help at home with tasks2 6 10 4 5 19


Notes: 1. With cooking, cleaning and laundry. 2. From friends, relatives or workers.

Interviewees who had permanent housing

Forty subjects had permanent housing when interviewed, and most were living alone. 34% had

been in their accommodation for six months or less, while 29% had been so housed for more than

five years. Many described problems with coping at home (Table R5.6). Twenty-one had

45

problems with paying bills, including 17 who had rent arrears or other debts. Seventeen described

difficulties with managing household tasks such as cooking, cleaning and laundry. The subjects

interviewed in Manchester were least likely to report having help at home with household tasks or

with paying bills (although one person was helped with the latter by the centre). Use of wet centres and services received

Almost two-thirds of the interviewees (62%) used the wet centres at least four days a week, and

many also used other centres (Table R5.7). One-quarter had been attending the wet centre for less

than one year, while almost three-fifths had been attending for more than two years. The subjects

at the Booth Centre were most likely to have used the centre for more than two years (72%), and

just a small proportion were very recent attenders. Similarly in Nottingham, two-thirds had

attended for more than two years. In contrast, only 40% at the Anchor Centre in Leicester had

attended for this length of time.

Apart from the subjects interviewed in Leicester, many others had meals or snacks while

at the wet centre. The centre in Leicester was the only one that charged for food, albeit a nominal

amount, and it provided only rolls and no hot meals. These factors may have deterred some

clients from eating at the centre. Where available, showers and laundry facilities were used by

several clients, who tended to be rough sleepers. Very few who had tenancies or were in hostels

used these services.

Table R5.7 The subjects’ use of the wet centres (%)

Features of service Handel Street

Tollington Way

Booth Centre

Anchor Centre

Total

Uses wet centre 4+ days / week 76 64 48 61 62

Uses other centres 68 80 72 77 74

Attendance at wet centre:

less than one year 29 36 12 28 26

more than two years 67 54 72 40 58

Services used at wet centre

showers 40 40 n.a. 46 32

laundry 60 32 n.a. n.a. 27

meals or snacks1 64 60 76 38 59

Help from staff:

with social security benefits 36 40 52 19 37

with housing problems 32 28 28 35 31

with sorting out bills / debts 12 8 16 8 11

emotional support 48 4 52 15 30


Notes: n.a. not available. 1. 3+ times a week

46

The help that the subjects received from health care workers and specialist substance misuse

teams has been noted earlier. They also received various types of assistance from the wet centre

staff, most commonly with sorting out social security benefits and housing (Table R5.7). One-

half in Nottingham and Manchester said that they received emotional support from the staff and

were able to talk about their problems. This was rarely reported by the London interviewees. The

difference does not reflect whether or not a centre has a key-working system, as only Leicester

and Nottingham had it in place for some clients. One important factor may be that in Nottingham

and Manchester the staff were involved in activities and outdoor pursuits with the clients. Many

staff at these centres said that they had developed better rapport with clients while pursuing

activities as the clients were more relaxed and willing to talk about their problems. This suggests

that engaging with clients in this way is effective for some people with serious mental health and

substance misuse problems and chaotic behaviour who may be wary of traditional case-work.

Information was obtained about changes in housing circumstances and alcohol consumption

since attending the wet centre. It has to be remembered, however, that many clients who have

experienced such changes will have stopped attending the centre. The following figures provide

therefore only partial evidence of the extent to which wet centre users’ circumstances have

changed. More than one-third at the Booth Centre in Manchester had acquired permanent or

temporary housing, as had slightly fewer at the centres in Leicester and Nottingham (Table R5.8).

The loss of a tenancy was most commonly reported by the Leicester interviewees, and the overall

statistics for the Anchor Centre showed that 16 tenancies had failed during 2002/03 (see chapter

R4). Relatively few London interviewees described changes in their housing circumstances.

Table R5.8 Changes in housing and alcohol consumption since attending wet centres (%)

Characteristic Handel St. Tollington Way

Booth Centre

Anchor Centre

Total

Housing situation:

Obtained temporary housing 8 4 16 12 10

Obtained permanent housing 16 8 20 15 15

Lost a tenancy 12 12 16 27 17

Alcohol consumption:

reduced / more controlled 24 8 20 23 19

increased 24 8 16 12 15


One-fifth of the subjects said that their drinking had reduced or was more controlled since

attending the wet centre. Nearly as many, however, reported an increase in their alcohol

consumption. As with their housing circumstances, relatively few London interviewees described

changes in their drinking habits. These findings have to be interpreted carefully as they are only

47

the clients’ estimation of their alcohol intake. According to several staff, some clients used

alcohol as a substitutue for drugs and their drinking increased as their drug habit reduced. The

findings suggest however that wet centres do not intensify drinking among the users, contrary to

the belief of many agencies and reports. For example, a health impact assessment of a proposed

wet space in the grounds of a hostel in Exeter suggested that one of the negative impacts was that

‘creating a group-drinking environment could lead to people drinking more because of sociable

circumstances’ (Health Forum, undated, p. 13). More comprehensive information is needed about

the impact of wet centres on alcohol consumption before conclusions can be reached.

The subjects’ opinions of wet centres

Most subjects (84%) believed that wet centres are beneficial, and the most frequently cited reason

was the social aspect (Table R5.9). Seven-tenths described the centres as a place where they can

meet friends, socialise and overcome loneliness. 44% mentioned being able to drink on the

premises as an advantage, and almost as many referred to the basic services that are provided.

Just one-quarter believed that wet centres are useful in helping to sort out personal problems. One

likely reason is that in many cases alcohol is used as a means to escape from personal difficulties.

To overcome these problems it is necessary to distance oneself from a wet centre.

Table R5.9 The subjects’ opinions of the wet centres (%)

Opinions Handel Street

Tollington Way

Booth Centre

Anchor Centre

Total

Benefits of wet centre:

allows drink / has few rules 76 48 20 31 44

basic services, e.g. meals 40 40 12 54 37

sort out personal problems 32 8 32 23 24

social contacts 72 72 64 73 70

Mentioned any benefit 92 92 64 88 84

Ways to improve wet centre:

open longer hours 96 50 44 64 63

better facilities1 36 8 44 0 22

more basic services2 44 20 36 23 31

more personal help from staff 20 12 16 19 17

more help with housing 44 32 36 15 32

more activities 12 32 4 27 19

more staff control of clients 20 4 4 15 11


Notes: 1. e.g. larger premises, better shower and toilet facilities. 2. e.g. more meals or drop-in sessions.

48

Various ways of improving the wet centres were proposed, and these differed by location. Almost

two-thirds of the subjects believed that the centres should be open longer, and almost all at Handel

Street in Nottingham had this opinion. The Nottingham and Manchester interviewees also

believed that there should be better facilities, such as larger premises, showers and toilets, and

more basic services, such as meals and drop-in sessions. Both these centres are small, and have

restricted hours for drop-in sessions. Booth Street does not have showers, while the showers and

toilets at Handel Street are unisex. Since the intervie ws were conducted, Handel Street Centre has

extended its opening hours.

The subjects in Leicester and London suggested that there should be more activities at the

wet centres. Both these centres have few activities, although the Anchor Centre is planning to

increase this provision. Just 17% of the subjects were of the opinion that more personal help

should be provided by the staff, although several in Leicester said that they would like to have

counselling. This is consistent with the earlier observation that some clients prefer that the

personal support from centre staff is through engagement in activities rather than formal case-

work. Summary

This chapter has described the vulnerabilities and multiple problems of many people who attend

wet centres. Most interviewees had physical health and alcohol problems, and many had dual or

triple mental health, alcohol and drug problems. For many, alcohol contributed to the loss of

tenancies and jobs, and to marital and family breakdown, and nearly all had been homeless at

some time. Even among those who were housed when interviewed, most had problems with

managing at home and several had rent arrears and debts. At the wet centres, they accessed basic

services such as meals and showers, and received help from the centre staff and specialist workers

with obtaining and sustaining housing, with sorting out bills and social security benefits, and with

addressing health and substance misuse problems. Many used the wet centres several times a

week, and three-quarters also used other centres. Despite their frequent attendance at various

centres, several still said that they would like the wet centres to be open longer.

One-half continued to drink alcohol on the streets and in parks most days. According to the

Anchor Centre staff, some clients drink on the streets only when the day centre is closed. Surveys

by the local police and outreach workers indicate that drinking in certain public places has ceased

during the day. This suggests that wet centres play a crucial role in providing essential services

for street drinkers and other vulnerable groups, and that they lessen but do not entirely stop street

drinking.

Manual

49

The roles and operation of ‘wet’ day centres in British towns:

A guidance manual

Aims and structure of the manual

The remainder of the report is a manual and guide to the design, planning and running of ‘wet’

day centres for the street drinkers and other indigent and exceptionally vulnerable people who are

found in towns and cities throughout the United Kingdom. It is based on the findings of a short

study of wet centres in England, as described in the preceding research report. It has been

informed by our interviews with not only the commissioners and staff of the existing centres, but

also with the clients and with housing, health, social service staff and the police who have had

close involvement with the centres or with services for equivalent vulnerable people.

The aim of the document is to provide a concise and clear guide to the important roles that

‘wet’ centres play, to the necessary and optional design requirements, and to the demonstrably

effective (and ineffective) ways of working. The research has led us to a challenging threefold

conclusion, that in the spectrum of a town’s services for homeless and vulnerable people:

• Wet centres can be an important element of an essential role, to provide a first point-of-referral

and contact for those who are excluded or unable to use conventional or mainstream housing,

health, addiction and social services, where help is provided and people are started on a path to

treatment and a return to less problematic and more conventional lives.

• There is no single optimal specification of the roles, ownership, management and day-do-day

operation of such a centre, for the most effective configuration is a function of local needs,

agencies, services, and political and professional environment.

• Wet centres can be difficult to run and can become less effective than they should be. Their

continuing success depends upon close attention to several internal and external operational

requirements, the maintenance of which requires vigilance and frequent attention. These include

keeping the objective of helping clients to control drinking to the fore, and of maintaining good

local community relations.

In short, the role is vital but its delivery is by nature fragile or unstable. The remainder of the

document elaborates the above three propositions.

The manual has four chapters. They have been compiled on the assumption that, as part

of a local homelessness review and in association with a local (town centre) management policy,

consideration is being given to the establishment of a facility for street drinkers, that connects

them with services, and makes a contribution to the reduction of the problems associated with

street drinking. The first chapter discusses the choices that have to be made about which client

groups are to be served by a wet day centre and therefore is also concerned with the aims of the

centre. Chapter M2 is a digest of the issues that must be considered and the decisions that have to

be made when designing and planning a centre, and its role in a local spectrum or network of

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services. The third chapter is a synthesis of good practice points on working with street drinkers

and other vulnerable groups, while the last chapter concentrates on various management issues

and gives particular attention to the difficult task of keeping the more challenging aims to the fore.

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M1 Determining the clients to be served and the centre’s aims

The client group

The wet centres that are operating in England today have had different origins and patterns of

development, and the profiles of their clients are not identical. It is clear, however, that they are

not only providing help to street drinkers, but are also working with people who have mental

health and drug problems, rough sleepers, ex-offenders, sex workers, and those who are unsettled

and move from town to town. The client group has several distinguishing characteristics:

problematic and self-harming behaviour; poor motivation to seek help and address problems;

disconnection from family and friends; and exclusion from conventional welfare services which

they either will not or cannot use. The clients are therefore among the socially weakest and most

vulnerable in our society.

There is still remarkably little systematic evidence or well-grounded understanding about

the causes of and pathways into homelessness and street behaviours in contemporary Britain.

Figure M1.1 presents a schema of the main biographical features, negative events, and

problematic behaviours that are associated with, and sometimes cause, homelessness and acute

social deprivation and disadvantage. At any one time, some people have recently entered this

state having experienced traumatic events or the collapse of roles and standing. Others are

entrenched in a syndrome of disadvantage and exclusion that began early in life with problems at

home and in school, and is characterised by few social or productive skills and little ‘human

capital’. Such disadvantage and deprivation is often reinforced later by failures in personal

relationships and work.

There are in fact several groups of severely disadvantaged people in every contemporary

town and city, and many have multiple neglected problems. When designing a ‘wet’ day centre in

a town or city, it is important to consider the client group to be targeted because it will quickly be

found that, for example, not all street drinkers are homeless and not all the users who can benefit

from such a facility will be street drinkers. It is therefore important not only to review the

services that are available for street drinkers, but in parallel to examine those that serve closely

related groups of the disadvantaged and socially excluded population.

The distinctiveness of street drinkers

The ‘wet’ name implies a service dedicated to (although not necessarily exclusive to) clients who

are heavy drinkers, have health and social problems, and are poorly motivated to stop drinking.

The problem manifests in drinking in unlicensed places, particularly town and city squares,

doorways and public parks, by people who engage in the habit not occasionally (as do football

supporters or arts festival attenders) or as an element of a social excursion, but for many hours on

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Figure M1.1 The syndrome of lifetime or recently acquired severe disadvantage and exclusion

Lifetime of acute disadvantage

Low education/skills/human capital Low social/inter-personal skills

Weak social support

Chronic unemployment and low income

Recent collapse of roles and standing

Family/relationship breakdown Onset of mental illness

Redundancy or unemployment

Low income

Problematic and harmful states

Lack of family/social/economic roles

Difficulty in sustaining tenancies

Homelessness

Problematic and self-harming behaviour

Street socialising and drinking Substance abuse and addiction

Transient and chaotic behaviour Begging Petty crime Sex work

Criminal record Prison or custody

Low morale, self-esteem and depression

Poor motivation

Mental health problems

High morbidity Untreated

physical illnesses Premature death

many days. Other characteristics are the type of alcohol that is consumed, and the sharing of

drinks. Street drinkers often consume cheap but strong beer, cider or sherry, which some conceal

in plastic bags. Some share bottles of cider or sherry and are seen drinking from the bottles. It is

unusual to observe these drinking habits among social drinkers.

The client group is not defined exclusively by its drinking habit, but also by its social

marginality. They are people who drink alone or in groups who are perceived not as ‘lads on a

night out’, but as down-and-outs, the chronically unemployed, the homeless, rough sleepers and

beggars. Linking all these states, in many people’s perception, is failure, exceptional bad luck and

low personal resolve, and for that reason the group is unsettling and discomfiting to many. Some

members become intoxicated and boisterous, flirtatious, argumentative or aggressive. Some may

behave indecently and, for example, urinate in the street. Some have mental health problems that

associate with bizarre and occasionally intimidating behaviour. Individuals therefore can

sometimes be problematic and generate incidents which are a public nuisance.

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Aims of wet day centres

Wet day centres have two over-arching aims: (i) to provide support, help and treatment for

severely disadvantaged and chaotic people, including street drinkers, who are excluded from other

services; and (ii) to tackle an anti-social behaviour problem in a constructive, non-criminalising

way.

The first aim has multiple elements which can be grouped as follows:

• A point-of-contact for the most vulnerable who are disengaged or excluded from services and have multiple or serious unmet needs.

• A safe, non-judgmental environment at which basic needs for food, shelter, safety, personal hygiene and sociability are provided.

• A setting at which a vulnerable person’s housing and other more specialised needs can be assessed, and from which the help of other agencies can be enlisted.

• A setting at which those with alcohol dependency can be encouraged and helped to develop new interests, activities and occupations, in order to build confidence and self-worth and reduce or control alcohol problems.

• A point-of-contact for outreach workers and other agencies who can meet and work with clients who are hard-to-reach or have challenging behaviour.

In October 2002, the NHS National Treatment Agency for Substance Misuse published Models of

Care for the treatment of adult drug misusers (National Treatment Agency for Substance Misuse,

2002). Although the primary focus is adult drug treatment, its relevance to the development of

alcohol services is explicitly stated. It asserts that drug misusers in all local areas should have

access to four tiers of services: (i) non-substance misuse specific services requiring interface with

drug and alcohol treatment; (ii) open access drug and alcohol treatment services; (iii) structured

community-based drug treatment services; and (iv) residential services for drug and alcohol

misusers. Wet centres are the equivalent of the second tier of services. These are low-threshold

projects which aim to engage substance misusers in treatment and harm reduction services, who

do not necessarily have a high level of commitment to structured programmes.

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M2 Planning and setting up a wet centre

All local authorities in Great Britain are required to produce both homelessness strategies and

community safety strategies, and many are contemplating town and city centre management

policies with more coercive measures against beggars, street drinkers and others who engage in

anti-social behaviour. For these reasons, several are considering providing wet day centres as an

alternative venue to the streets for drinkers and, more importantly, as a point-of-contact into

services for those who are excluded and have unmet needs. This chapter describes many of the

issues that need to be taken into account, and many of the steps that should be taken, when

planning and setting up a wet centre.

Review of needs and the adequacy of current services

A Working Group, possibly of an existing multi-agency homelessness forum, should be set up to

examine the extent of street drinking and other street behaviours in the locality and decide if a wet

centre is needed. It should have representatives from statutory and voluntary sector agencies,

including housing, health, substance misuse and social services. If the decision is made to go

ahead, the Group should steer the project through its development phase, with one agency taking

the lead. For example, Leicester City Council Housing Department became the lead partner for

establishing the Anchor Centre, but worked in partnership with many other agencies (described in

Chapter R3).

The first steps are to establish the number of street drinkers in the area, to map the locations

that are used, to gauge the nuisance that is caused, and to produce an annotated inventory of the

services that are available for drinkers and their usage. A simple survey of the numbers of street

drinkers who are homeless, are not registered with GPs, have untreated health problems, and their

eating habits would normally show substantial and serious unmet needs. Some drinkers and other

street groups make heavy use of hospital accident and emergency departments for primary health

care needs. It will not be difficult to make a strong case for the creation of a drop-in or day centre

if there is no equivalent facility. The strength of the case for dedicated ‘wet’ provision will

depend on the number of local street drinkers who are excluded from or not in contact with

services.

In reviewing the adequacy of services, information should be sought not only from the

provider agencies but also from (i) workers of outreach teams and homeless advocacy

organisations that have detailed knowledge of the client groups and their use of local services, (ii)

agencies such as hospital accident and emergency staff, the police and street wardens, and (iii) a

sample of the drinkers. On paper it may appear that a required service is available, but the users

may explain that they are barred from services or have to leave hostel premises during the day.

Other reasons, including intimidation or aggression from existing clients, may also explain why

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some people are reluctant to use a service. The creation of a wet centre may not be necessary. It

may be tha t existing projects should be given more resources to remain open during the day, to

employ additional staff so that the environment is less threatening for users, or to restructure or

expand their services to include specialist help for street drinkers.

Who will the centre serve?

In most towns different groups of highly disadvantaged, vulnerable and chaotic people are well

and less well served by its statutory and voluntary sector services (described in Chapter M1). The

best configuration and setting of a ‘wet facility’, i.e. as a discrete, dedicated service or as part of a

day centre complex for multiple client groups, should be decided after discussion with several

agencies. There are different views about whether there should be separate day centre facilities

for drinkers, but little evidence about the relative merits and effectiveness of separate or integrated

facilities. At the Anchor Centre in Leicester, the staff have found it difficult to run a combined

wet and generalist day centre, and believe that the best option would be for the centre to serve

only drinkers and drug users. Although it is open all day for the drinkers and in the afternoons as

a drop-in service, the afternoon sessions are often very busy and the staff’s time is sometimes

diverted from the drinkers who need a great deal of support. There are also concerns that mixing

day centre users with heavy drinkers may encourage drinking among the former, and that clients

who want help to overcome a drinking problem find little reinforceme nt when interacting with

people who are drinking. It has been suggested that the centres should provide separate sessions

for those who are reducing their alcohol intake.

Other staff believe that the centres should not be exclusively for drinkers. Providing for

various client groups creates a more balanced and less stigmatising environment, and means that

people do not have to stop attending the centre if they stop or reduce their drinking. By mixing

with non-drinkers, the drinkers would see how they manage and what they achieve, and this may

encourage them to tackle their own alcohol problem. In addition, many clients have multiple

problems and separating different groups results in some being excluded (many are already

excluded from mainstream services). The Booth Centre staff have found that it is possible for

people to stabilise and reduce their alcohol intake while attending wet centres.

The decision about the client group to be served will probably be influenced by the

availability of premises (discussed later), the extent of the problem, and the local service

configuration. For example, if a town has a small-scale problem of rough sleeping and street

drinking but no day centre facilities for homeless people, it would be more appropriate to esta blish

a single first-point-of-contact centre, with provision for the drinkers. This was the case in Chester

(the Harold Tomlins Day Centre, described in Chapter R3). On the other hand, in a large town or

city where there are day centres for homeless people which are well-attended, a separate centre

might be needed for street drinkers and other problematic client groups whose needs are not met

by existing services.

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What kind of organisation should run the centre?

Two of the four centres that have been closely studied are run by independent, single facility

charities (The Booth Centre and Tollington Way), and two by multi-facility specialist housing and

welfare agencies (Handel Street and The Anchor Centre). While it cannot be said that any one

form of ownership and management has a net advantage over others, our observations of these

and other homeless people’s facilities, together with substantial research on the contribution of

voluntary organisations to welfare services (Craig and Manthorpe, 1999; Middle ton, 1999),

suggest that different types of organisation have specific strengths. This section compares the

most apparent management strengths of specialist, single facility organisations, multi-facility non-

profit welfare and housing organisations, and statutory agencies.

In recent years across the British Isles, several groups and formal charities have

established drop-in and day centres for street drinkers and homeless people. Many have had a

precarious existence, principally because of uncertain funding, but also through stormy relations

with their landlords, neighbours, the police, the general public and the local media. On the other

hand, many dedicated groups and organisations demonstrate exceptional enterprise, innovation

and tenacity. It should be remembered that several of the largest and best known specialist

regional homelessness organisations and housing associations began as single facility initiatives,

as for example St Anne’s Shelter and Housing Action, based in Leeds, that began as a day centre

for shelter and hostel residents that were excluded from their accommodation during the day (See

http://www.st-annes.org.uk/ and Spiers 1999).

Now that local (authority) homelessness reviews and strategies have been instituted, and

local multi-agency forums and co-ordination groups have spread, it may be that there will be

fewer opportunities for new organisations to fill service gaps. The most feasible form of facility

development in the future is likely to be for an established social housing (and welfare) provider

or a statutory agency to be commissioned by a strategic statutory body to organise and provide a

service. In practice, many developments will arise from agency partnerships. Some local

authorities are planning an elaboration and consolidation of services for rough sleepers, other

single homeless people and those with substance abuse problems in expanded ‘one stop’ centres.

The local authority housing department (that has overall responsibility for homelessness services)

will organise the capital funding, but the staff and services operating from the centre will very

often be funded by several non-governmental and statutory agencies.

The best local arrangement will be a function of the availability of funding for the centre and

of the duty upon, capacity and enthusiasm of the town’s various statutory and voluntary housing,

primary health care, mental health and addiction agencies to provide services for the centre’s

clients. Some general associations can however be observed or suggested, as is attempted in

Figure M2.1.

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Figure M2.1 Administrative and management strengths of different types of organisation

Single facility charity Multi-facility RSL or

welfare charity Statutory agency

Funding

Normally highly insecure

Dependent on public funding priorities

Dependent on public funding priorities

Administrative and developmental capacity

Variable, legal and financial experience often with advisers and trustees rather than staff.

Little capacity to develop move on (or vertically integrated) services.

Established and experienced support with planning and with legal, employee and

client responsibilities. Demonstrated capacity to

develop move on and specialist services.

Established and experienced support with planning and with legal, employee and

client responsibilities. Demonstrated capacity to

develop move on and specialist services.

Volunteer involvement

Considerable goodwill encourages volunteers

May be difficult to reconcile with staff interests

Weak tradition of working ‘alongside’

Staff levels, training and support

Rarely able to provide back-up for sickness or holiday leave,

or to have sufficient funds and leeway for training. No

opportunities for in-house career progression.

Can deploy back-up staff, and have capacity for training,

appraisal, staff development and progression.

Can deploy back-up staff, and capacity for training,

appraisal, staff development and progression.

Onward referral to specialised agencies

Possible, but only with exceptional collaboration from

other (competing) charities and statutory agencies. Highly

dependent on charisma of leading personnel.

Normally extensive and to a high standard, although the

links are vulnerable to the loss of statutory agencies’

goodwill.

Normally extensive and effective although the general

problems consequent upon boundaries between various agencies and welfare sectors.

There are many instances of the enterprise, drive and enthusiasm of a dedicated charitable

organisation delivering high quality and effective work with clients in a specialist facility, often

with substantial contributions from volunteers. These strengths are however counterbalanced by

the heavy dependence on a small team, and by the ‘separateness’ of the facility from the wider

network of local services. The lack of the administrative and management capacity and

experience of a larger organisation creates several difficulties, especially with external relations,

development and continuation. Larger employers are likely to have more ability to deploy back-

up staff, for example, to avoid the closure of a facility because key staff are sick or on leave, and

to have staff support, mentoring, development and training capacity.

The other important differentiator of the single facility charity from either large, well

established non-governmental organisations or statutory agencies is likely to be their ability to

establish and maintain the inward and onward referral pathways. The problem arises from both

the little time that a small team has to spend on networking, negotiation and inter-agency

relations, and from the professional and organisations barriers that normally exist between

statutory and voluntary agencies and between established and new organisations. On the other

hand, whatever the type of organisation providing a specialist welfare service for ‘marginal’ client

groups, the vagaries of changing policy priorities will affect continued funding. There may be

different funding insecurities for the different types of organisation, but none are immune.

Further comments on the management of centres are made in Section M4.

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Premises and location

Finding suitable premises and gaining the necessary approvals and permissions for their use as a

facility for homeless people is not easy. The usual difficulties are compounded when setting up a

wet centre given the generally negative public reputation of the client group, and the possibility

that the centre will attract street drinkers to a new location.

The centre should be in neither a residential area nor adjacent to schools, children’s

playgrounds or other sensitive facilities, nor should it be in or next to a shopping or tourist area

with high pedestrian densities and many visitors. Some users will inevitably drink in the street on

their way to or from the centre, and a high frequency of problematic behaviour will be noticed and

brought to the attention of the police, who will be obliged to intervene. Areas should also be

avoided that already have extensive provision for other social problems, such as hostels for

homeless people or for ex-offenders, and that are very run down, uniformly depressing or the

‘back of beyond’. The location should be accessible, which means principally that it is in walking

distance from the town centre for the great majority of the likely clients. In summary, the ideal

area should be an unremarkable part of the inner city in which ‘life goes on’ but there is not a high

density of residents.

It is a great advantage if a wet centre is near a local health centre or practice that accepts

homeless and chaotic patients (unless comprehensive health care is to be provided at the wet

centre). There are similar advantages if the centre is proximate to benefits, housing advice and

citizens’ advice bureaux. If a centre is designed to have sessions or clinics with many visiting

specialist workers, inadequate or unsafe car parking provision may reduce the co-operation of

other agencies and thus the effectiveness of the centre’s work.

Most of the existing wet centres are small and the working conditions are cramped. The

centre needs to be of a reasonable size to accommodate clients who have disturbed behaviour, or

are wary of or irritated by being in close proximity to others. Overcrowded conditions are likely

to increase tensio ns and lead to arguments and possibly aggression. The centre also needs to have

sufficient offices so that staff and specialist agencies can see clients individually in a quiet

environment. The clients cannot be expected to discuss personal problems or care-plans in a

noisy room in front of other users. Ideally, the centre (or at least the area used by clients) should

be confined to a single floor. The Brighton centre occupies two floors, with a wet room

downstairs and a dry room and dining room on the first floor. It is difficult to observe the clients

and staff are required on both floors at all times.

Overcoming local opposition and gaining planning approval

Gaining planning approval is often refused for a homeless people’s service proposal, and

commonly the main reason is the strength of local objections. This means that acquiring the early

approval and support of the local authority and of the local councillors is a critical step. If the

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need for a facility is stated in the local authority’s homelessness strategy, the relevant committees

will be less readily swayed by objectors.

Local authorities, NHS agencies and churches (in that order) probably have a head start in

getting planning approval for homeless service proposals. The first can through its committees

and elected representatives ‘test’ the levels of support and objection for a proposal before it is

submitted. Health agencies and churches draw on special goodwill and (even today) deference.

Nonetheless, many homeless service proposals made by these most influential and well connected

bodies face vociferous opposition. It is therefore important that high quality information about

the aims and running of a wet day centre is prepared well in advance of any publicity about a

proposal, and that there is intensive consultation with the immediate neighbours and local resident

groups and businesses. Organisations that are inexperienced in these matters should seek advice

from many quarters before embarking upon a planning application.

At Tollington Way in London, the staff consulted widely with the local community before

the project was established through meetings and door-to-door calls. They introduced themselves

to local residents and businesses, explained the centre’s aims and intended work, and distributed

information leaflets. They also asked local residents to join the Management Committee, so that

the local community perceived that they had some input into the centre’s development. Similarly,

at the Specialist Dependency Service in Camden Town, London, the most vocal opponents to the

day centre were invited onto its Steering Group. The Camden Town centre also designed a

‘Neighbourhood Management Policy’, which states the staff’s responsibilities and commitment to

the local communit y, and was distributed to local businesses and residents (the policy is described

in Chapter M4).

Funding

Every local authority has access to several possible sources of funds to support the creation and

running of a wet day centre. Special project funding is available from the Homelessness

Directorate of the Office of the Deputy Prime Minister (ODPM), and other sums can be made

available through ‘Supporting People’ and ‘Floating Support’ contracts, and from various Home

Office and ODPM ‘community development’ and ‘regeneration’ programmes. The larger British

city councils now organise and direct substantial sums into services for homeless people.

Reducing health inequalities and reducing unmet health care needs are priorities for the

National Health Service. Developing services for homeless people was a named priority for

Personal Medical Services funding, while more generally the new NHS Primary Care Trusts have

been charged to develop services for homeless people and other high needs groups. General

medical practices and health centres that work with homeless people generate high rates of patient

contacts and of prescriptions for both medication and addictive-drug surrogates. They must

formulate a clear prescribing policy, make this widely understood among the relevant client

groups, and be able to demonstrate to the NHS commissioners and auditors that the policy and

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prescribing practice is rational and responsibly applied. The evidence from Nottingham and

Manchester suggests that when this is done, there is no ceiling on the drugs budget although all

practices with high spending find that it is repeatedly challenged.

Recent years have seen substantial funding programmes to tackle drug addiction. A well

argued case for a specialist worker has a good chance of funding. On the other hand, there are

many reports of too few resources for alcohol services. The Anchor Centre in Leicester originally

focused on street drinkers, but later extended its responsibilities to include drug users. This

attracted funding from Leicester Drug and Alcohol Action Team. The staff believe that the move

was beneficial as many of their clients have both alcohol and drug problems, and the funding has

allowed them to improve their service.

Nottingham City Council has taken an interesting initiative in creating the post of ‘Homeless

Strategy Co-ordinator’ with a responsibility to seek out and win new sources of funds for

homeless people’s services. It is thought that while ‘Housing’ and ‘Social Services’ will always

be the ‘big players’, additional funds might be won for programmes in the ‘Leisure and

Community Services’ and ‘Education’ areas. The ambition is also to look for additional funds

from regional, national and European programme sources. On the former, the devolution of

substantial sums from the Housing Corporation budget to regional housing agencies linked to the

regional Government Offices and Development Agencies is thought to be a pattern that will be

repeated with other programme budgets.

The involvement of specialist service providers

If a wet centre is to be effective, it will require input from specialist agencies to deal with the

complex health, substance misuse, housing and social problems of the client group. It is critical

that these agencies and others, such as the probation service, are involved at an early stage in the

centre’s development. In Leicester, all relevant agencies were committed to the wet centre

through a ‘memorandum of understanding’ drawn up at the planning stage. As a result, the centre

receives a great deal of input from the various agencies. In contrast, no partnership arrangements

were sought when Tollington Way in London was established, and after opening the clients’

unmet needs soon became apparent. The centre has since had great difficulty in getting help from

specialist services, and more than three years later no primary health care service is linked to the

centre.

A wet day centre either needs primary health care services on-site or to be closely linked and

jointly planned with a nearby health centre with an interest in the client group, as in Nottingham,

Manchester, Brighton and Oxford. Specialist health services enable screening, disease

management and health promotion work to be carried out with clients who may not comply with

traditional services. In Leicester, Nottingham and Oxford, the GPs and nurses provide a home

detoxification programme. Good links with community mental health teams also need to be

developed. Many wet centre clients have apparent or underlying mental health problems, and will

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require mental health assessments and possibly treatment. Several of the current wet centres have

input from specialist mental health teams for homeless people, but find it difficult to link the

housed attenders into mainstream mental health services.

Links to specialist substance misuse workers are essential. Clients will require expert advice

on reducing or controlling alcohol intake, on the effect of alcohol and harm minimisation

strategies, and on the types of treatment and support programmes that are available. The workers

will also play a crucial role in assessing the clients’ needs and motivation for treatment, and in

linking them into alcohol and drug services. If the workers visit the centres regularly, the clients

will become familiar with them, and may be encouraged to accept advice and help.

The involvement of local authority social services departments (SSDs) should be sought. At

the centres in Leicester and Manchester, social workers visit weekly and fulfil many useful

functions. They carry out community care assessments of the clients who wish to be admitted to

alcohol rehabilitation programmes or residential care (both of which are funded through local

authority SSDs), and arrange the placements. They also help clients obtain housing and social

security benefits, and assess the needs of those who are housed and arrange for services at home

such as meals-on-wheels, home care, aids and adaptations, and tenancy support.

Housing and support services

Attention has to be given at an early stage of the planning to the housing and support needs that

will be generated. Through years of heavy drinking and related physical and mental health

problems, many street drinkers require supported housing or residential care as either an interim

or long-term measure. Links need therefore to be established with social housing providers, and

housing quotas and referral procedures set up.

There are difficulties in finding suitable accommodation for clients who continue to drink. In

some cases, statutory services refuse to accept responsibility for a person until their situation has

deteriorated and they require a residential care-home. Many towns and cities have no residential

homes for heavy drinkers and so clients are placed in homes for older people. This can lead to

problems for the clients, the staff and the residents of the home. Moreover, many heavy drinkers

who require supported housing are young or middle -aged.

In response to the shortage of suitable accommodation, some organisations have

developed their own housing. Equinox, which runs the wet centre in Brighton, in early 2003

opened a ‘wet house’ nearby as permanent accommodation for five heavy drinkers. It is funded

through Housing Benefit and Supporting People revenue. Most of its residents are in their late

forties or older and disabled or physically frail. The Oxford Night Shelter manages the city’s wet

centre and developed supported housing for 60 clients in eleven houses rented from private

landlords. The organisation renovated the properties and the tenants receive help from four

supported-housing workers based at the project.

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The role of the police

The police have supportive, restraint and punitive roles in relation to street drinkers and wet

centres. Local beat or town-centre team officers have detailed (if particular) local knowledge of

both ‘street people’ and the agencies and facilities that offer help. Very often, a police officer is

the first to make contact with a rough sleeper or street loiterer new to the area, and can play a very

useful role in informing them about a wet centre and the services that it offers. They are also

responsible for maintaining law and order, including ensuring that alcohol bans in designated

areas are adhered to. They may thus be required to caution a street drinker or take further action if

the person is breaching rules or their behaviour has raised public concern. As one police officer

reported when interviewed, ‘there is a fine line between policing the streets and supporting the

work of the wet centre’. The police have special responsibilities with inconsistent elements that

can be readily misunderstood

The local community police, and those attached to homeless, anti-begging and sex work

teams, should be involved at an early stage in the planning and setting up of a wet centre. They

will undoubtedly be involved if an increasing number of street people in the locality produces

complaints from local residents and businesses, and more serious offences suc h as drug dealing

occur. They should also be encouraged to refer new street contacts to the centre. It is therefore

vital that they have up-to-date knowledge about wet day centres and the services that are

provided. This is not a one-off task, because personnel change and memories are short. When the

Old Steine Day Centre in Brighton was established, the police set up a ‘drunk and incapable

policy’ and regularly brought street drinkers to the centre. Some had tenancies but were about to

be evicted, and thus the centre staff could intervene to prevent tenancy breakdown. The policy

initially worked well, but over time there was a turnover of police and the protocol was

discontinued. In Oxford, the police direct drinkers to the wet centre, but in some cities the local

police have little or no contact with the local wet centre.

How will the centre attract the users?

The specification of the premises, the services it offers and the opening times must ensure that the

centre serves the intended client group. The next step is to encourage street drinkers and others to

use the centre. Some first contacts will be referrals from the police or street wardens, or self-

referrals that have been prompted by work-of-mouth recommendations. Local ‘grapevines’

among street people about the locations and opening times of soup runs, day centres and hostels

can be highly effective. Self-referrals should therefore be encouraged.

Not all street people are however connected. Some have newly arrived in a town or city,

while others are isolates or ignorant of services. It is therefore essential that regular and persistent

street outreach work is carried out to locate disengaged street people, build up rapport and trust,

and inform them about the centre and encourage them to attend. At a few centres, the staff

undertake this work but most rely on the city’s dedicated street outreach team for rough sleepers.

Many staff believe that it is best for existing outreach teams to carry out the initial street work

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with drinkers, as they have the time to go around the streets and have knowledge of the sites

where street people congregate. To use wet centre staff for outreach work would restrict their day

centre hours, and as for safety reasons street work needs to be carried out by two workers,

additional staff would be required. There is however value in centre workers accompanying the

outreach team on occasions, so that they can be introduced to new clients and re-establish contact

with those who have stopped attending the centre. This is the procedure in Brighton.

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M3 Working with the clients

This chapter describes the work that needs to be undertaken with wet centre users who have

alcohol problems. It draws on the experiences of the interviewed samples of clients and the staff

of the four wet day centres that were closely studied as well as the experience of other centres.

Engaging with clients

It is important that a wet centre is welcoming and attractive to new clients. Both the environment

and the staff’s responses have an influence. The rooms should be bright and spacious so that the

clients do not feel cramped. Some who attend may have been on their own for a long time and

have had little close contact with others. There should be posters and leaflets to inform new users

about the available services. The clients should feel safe at the centre, and not fear being bullied

or intimidated by other users. The ‘front-line’ staff should welcome new clients and explain what

the centre offers. They should take every opportunity to sit with and get to know the clients.

Volunteers can play an important role in engaging with clients and making them feel at ease. If

the staff team is sufficiently large, one could be designated the ‘welcoming worker’, and this role

be rotated periodically. The staff at the Booth Centre find that the wet garden is a useful setting

for engaging with clients. It is a relaxing environment and a ‘half -way step’ into the centre for

people who are wary.

Early contacts with a new client have to be handled carefully and tactfully. It is essential to

find out whether a new attender has a pressing problem, but insensitive probing may scare a

person away. Different approaches will be required for different clients. Some may wish to talk

to staff, while others may initially want to be left alone. The staff need to assess each situation

and interact with the clients accordingly. Once a client has engaged with the centre, the staff can

begin to collect information about his or her problems and needs.

Most centres do not have the space to provide separate facilities for women, and some

staff doubt whether these would be popular because many women have a male partner and do not

want to be separated. Many staff believe however that women attenders have particular issues

that they wish to discuss, and that a women’s group would be useful.

Assessing needs

Most wet centres collect basic personal information from a client when they first attend, but not

all undertake detailed assessments of the client’s problems and needs. In order to provide

significant help to a client, information is required about:

• Recent housing history, including whether housed, in temporary accommodation or sleeping

rough; recent and current problems with tenancies, including rent arrears and condition of

present tenancy; experiences of homelessness and reasons.

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• Family contacts and relationships, and social contacts with drinkers and non-drinkers.

• Income, state benefits received, and financial problems or debts.

• Physical health problems and nutrition.

• Morale and indications of depression, mental illness, unresolved stresses or memory

difficulties.

• Alcohol consumption, including types of alcohol, drinking pattern, history of heavy drinking,

reasons for heavy drinking, and involvement in alcohol treatment programmes.

• Use of illegal drugs or substances, and involvement in drug treatment programmes.

• Recent history of offending and contact with the probation service.

• Daily-living, personal care, literacy and social skills.

• Activities and engagement in community, work and training schemes.

Given this long list, the assessment must be carried out over time and cannot be completed at a

single interview. Opportune moments will have to be sought when a client is fairly sober and

willing to talk. Some clients will have mental health problems or cognitive deficits and be unable

to give accurate details, while some will be reluctant to provide information or will deliberately

mislead. Wherever possible, and if the client consents, information should be obtained from other

agencies who have had contacts with the individual. Needs, abilities and attitudes will change as

problems are resolved or ameliorated, and therefore assessments have to be frequently updated.

Several wet centre staff believe that not enough attention is given to assessing the daily living

skills of clients and their suitability for different types of housing. Even among the housed clients

interviewed for this study, many struggled to cope at home (Chapter R5). There should be

thorough assessments of clients’ daily living skills before long-term housing options are

considered.

Assessing risks

Most clients who attend wet centres are vulnerable, and some will have challenging behaviour.

The staff will be unaware of the histories of some clients, and it is essential that risk assessments

are undertaken and updated. A comprehensive document, Risk Management Policy and

Procedure, has been prepared by Broadway (2001) in London and can be downloaded from the

Internet (http://www.serviceaudit.org). As it states, an assessment aims for as realistic a picture as

possible of the risk that an individual poses to themselves and to other people. It is not normally

used to exclude a person from services but to ensure that the best possible service is provided by:

• Assessing whether the risk can be managed within a service.

• Assessing how to minimise risks to the individual concerned and to other people.

Risk assessments need to consider: (i) behaviour, including violence, abuse, harassment, the

likelihood of dangerous accidents linked to substance misuse or smoking, and persistent

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provocative behaviour; (ii) physical health, and risks associated with mobility, weight, self -

neglect and substance misuse; (iii) mental health, and the risks of self-harm and of bizarre

behaviour; (iv) daily living skills, including risks associated with preparing food and managing

appliances at home; and (v) the condition of the premises including the risks deriving from

outstanding repairs, infestation and faulty appliances, furniture and flooring. Meeting basic needs

Nutrition

Many heavy drinkers have poor diets, partly because they spend their money on alcohol rather

than food, and partly because they are prone to health problems which affect their appetite and

digestion. Most wet centres provide free food (either a cooked breakfast or a dinner). The Old

Steine Day Centre in Brighton also gives out multivitamins and Vitamin B tablets. Staff have

mixed views about whether there should be a nominal charge for food. Some believe that free

food encourages people to attend the centre, and ensures that they are getting at least one meal a

day. Others believe that it enables the clients to spend more money on alcohol and encourages

dependency.

It is important that wet centres address the nutritional needs of clients. An adequate

supply of free tea, coffee, soft drinks and water should be available at all times. Nutritious food

should be served at least once a day, including fresh vegetables and fruit. Bananas are popular

among clients with dental problems who find apples hard to eat. Attention should be given to

whether clients are eating, and some may need encouragement. If there is cause for concern, a

client should be referred to a primary health care nurse or a GP. If there is a charge for food, it

should be discretionary and depend on a client’s circumstances.

Personal hygiene

Some heavy drinkers neglect their personal hygiene, do not launder their clothes, and become

incontinent when drunk. Skin infestations, especially lice and scabies, are common among those

sleeping rough or living in neglected tenancies. Most wet centres have showers and laundry

facilities, or are close to other day centres with these services. The staff need to encourage clients

to attend to personal hygiene. Providing clean socks, underwear, other clothing and toiletries may

prompt some clients to shower and change their clothes. Leaflets about hygiene may encourage

interest. The nursing staff at Handel Street Centre distribute leaflets about health, and have found

that some clients will read them and respond with questions. There needs to be a clear policy

about managing clients with skin infestations. At the Anchor Centre in Leicester, the nurses treat

clients with lice.

Individual case-work

Care planning

Only a few wet centres carry out individual case-work with clients by a named worker (a key-

worker), who is responsible for ensuring that the person receives the help required. Most of the

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staff that were intervie wed recognised the value of this system, which ensures that interactions

with clients are followed through, and that the needs of withdrawn or undemanding clients are not

neglected.

Key-working implies that each established client has a key-worker who is responsible for

assessing their needs, designing a care-plan (action plan) with realistic goals, referring the person

to specialist agencies, and co-ordinating the person’s care. The care-plans should be prepared in

collaboration with the client and reviewed regularly. The plans should address immediate

problems, such as lack of income, poor nutrition, untreated illness, poor hygiene, and lack of

accommodation. They also need to tackle more complex issues such as alcohol abuse, long-term

housing and support needs, and building confidence, self-esteem and motivation. The ordering of

the actions should vary according to individual needs. Some rough sleepers may not be willing to

consider temporary accommodation until their confidence and self-esteem has increased.

Likewise, some heavy drinkers will not attend to personal hygiene until their alcohol problems are

controlled.

Many clients have long-standing problems and work with them will be slow. Key-working

should be paced to meet individual needs, and care-plans should be agreed when the clients are

sober and coherent. The key-worker will be able to carry out some of the agreed actions, such as

completing social security benefit forms, but they will also require the help of specialist workers,

such as primary care nurses and mental health teams. In such cases, care-plans should be co-

ordinated by the key-worker, but there should be regular reviews and liaison among the

contributing agencies.

Linking clients into services

Many clients will have had little or no contact with services for some time, and to address their

health and welfare problems it is imperative that such contacts are made. At some wet centres,

specialist agencies hold regular sessions, and the key-worker should ensure that the clients are

seen by these workers. In other instances, it will be necessary for the key-worker to arrange an

appointment for the client with a specialist agency. This will not be an easy task as some clients

may fail to keep or forget appointments, or become restless and leave a GP surgery if they are

kept waiting. Early morning appointments (before the person has drank much alcohol), and

escorting the client to ensure that they keep the appointment have proved useful.

Tenancy support

Several clients at wet centres have tenancies and live alone. But many who drink heavily find it

hard to manage at home. They neglect to clean their home and pay bills, some live in squalid

conditions, and rent arrears and tenancy failures are common. To combat loneliness, some have

their friends round, host ‘drinking schools’ and allow those without accommodation to stay. This

can lead to noise, disruptive behaviour and complaints from neighbours. Some do not report

problems or seek help until they are taken to court and evicted. It is very difficult to get home

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care services for these clients as home-helps are intimidated and refuse to go to flats where there

are several drinkers, and the clients are often not at home or refuse to answer the door when the

workers visit.

Many housed clients need tenancy support, some for a prolonged period if homelessness is to

be prevented. The centres have to decide whether to undertake this work or to refer clients to

other agencies (assuming that tenancy support teams are available). The advantages of the wet

centres being directly involved are that the clients already know the staff, and the staff are in

frequent contact with those who attend the centre. Moreover, as at the Handel Street Centre, it

brings variety to the work and enables the staff to follow the progress of the people that they are

helping through (for some) significant changes. Much of the satisfaction that staff and volunteers

draw from working with chaotic and vulnerable people is knowing that they have helped the m

make a difference in their lives. Those who are engaged in tenancy support work find that a great

deal of their time is spent sorting out rent arrears, helping clients to pay bills, intervening in

neighbour disputes, and arranging for the cleaning and furnishing of tenancies. Furthermore, joint

home visits are necessary when there are safety concerns. ‘Supporting People’ funds may be

obtainable for this work, which does require additional staff hours.

The social dynamics of wet centres

Among the clie nts of wet centres, characteristically there are many social relationships. The

significance of these relationships is heightened among a group of people that in general lack

intimate relationships and have only weak family contacts. Some have socialised with each other

for years on the streets and in hostels, and the group camaraderie is usually strong. They share

alcohol, lend each other money, visit each other at home, and generally support one another if not

always in constructive ways. Arguments occur but these are usually sorted out among

themselves. Their lives are interlinked. Past and present intimate relationships between users are

found, and at some centres couples with their adult children attend. Hence, when planning care

for a person, consideration has to be given to their relationship with peers, and how this might

impact on the help that is given.

Addressing alcohol problems

There is little robust evidence of the most effective ways to tackle alcohol problems among heavy

drinkers. Most staff who were interviewed believe that allowing clients to drink alcohol at wet

centres is a positive move. It encourages people to use the facility who are excluded from other

services, and it lessens the tensions between staff and clients who no longer have to be secretive

about their drinking. At the Booth Centre, the staff find that the clients who drink in the wet

garden are now more relaxed and their conversations are more meaningful.

It can however be extremely difficult (although not impossible) for clients to stabilise their

drinking while attending a wet centre as: (i) they are at the centre for only a few hours each day;

(ii) they are mixing with other centre users who are drinking heavily; and (iii) their social life

away from the centre tends to revolve around other drinkers whom they have known for years. If

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they wish to control or reduce their drinking, they may need to stop attending the wet centre,

break away from their drinking friends, and be referred elsewhere for help.

Rules around alcohol use

The wet centres have different rules about drinking on the premises. Some restrict the amount of

alcohol brought into the centre, while others do not monitor either the quantity or types – although

none would tolerate the consumption of toxic liquids such as ‘meths’. Some allow drinking only

in a designated room or garden, while others allow drinking anywhere on the premises.

Monitoring the alcohol that is brought into a centre ensures that large amounts are not consumed

on the premises. It is no indication, however, of the amount of alcohol that a person consumes

through the day. Many will have had alcohol before coming to the centre, some may share drink

while in the centre, and others may go outside to drink.

The staff expressed diverse views about the restriction of alcohol at the centres, and there is

little evidence to support or refute any of the various opinions. Those who oppose restrictions

believe that it affects the relationship with the clients and puts the staff into a ‘policing role’.

There is also concern that some clients might stop attending (although no such cases were

reported at the centres with restrictions). Those who hold these views recommend other strategies

for controlling the amount of alcohol consumed at a centre, including engaging the clients in

activities and providing a pleasant environment for which they acquire a sense of responsibility.

Those who are in favour of restricting alcohol give the following reasons:

1. It lessens (but does not eradicate) argumentative, aggressive and challenging behaviour, and

makes the environment more welcoming and safer for the clients and staff. Some needy

clients stay away if a centre becomes rowdy and volatile.

2. The centre should promote ‘harm minimisation’ interventions , and aim to reduce the damage

that clients do to themselves through alcohol. It should not be seen as a social drinking

venue, for that communicates that it is acceptable to drink irresponsibly on the premises.

3. It is impossible to work constructively wit h clients or to organise appointments when they

are very intoxicated.

4. Wet centre staff have responsibilities towards their clients, and it can be dangerous to allow

them to drink liberally on the premises. It is unknown what drink and drugs they have had

before coming to the centre, and heavy drinking at the centre could be lethal. Moreover, it is

irresponsible to allow the clients to become intoxicated while at the centre and then to turn

them out when the centre closes. There are health and safety implications for the clients,

and implications for the neighbours and general public.

Among the staff’s mixed opinions, there are common themes about drinking restrictions. Firstly,

most agree that it is irresponsible to allow clients to use the centre simply as a social drinking

venue and to permit the consumption of large amounts of alcohol. Secondly, there should be

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activities at the centre and other interests to engage the clients so that they do not drink just

because there is nothing else to do (discussed further in a later section). Thirdly, the staff should

‘monitor’ the amount of alcohol that clients are drinking and intervene in individual cases where

there is cause for concern.

There are several ways that the monitoring can be carried out. At the Booth Centre, staff are

in the wet garden with the clients at all times and observe the amount that individuals drink. At

the Anchor Centre, the clients record on an attendance sheet the amount of alcohol that they have.

This is not verified by staff (so the clients do not feel that they are being checked on), but the staff

are in the wet room with the clients and observe their alcohol consumption. In summary, if rigid

alcohol restriction rules are not imposed (and we do not recommend that they are), then it is

essential that the staff integrate with the clients, observe their alcohol intake, and intervene if a

person drinks excessively.

Detoxification and rehabilitation

Many clients who wish to tackle their alcohol problem require a period of detoxification while

their alcohol intake is gradually reduced, followed by a rehabilitation programme that lasts several

months. Extreme caution has however to be taken when encouraging clients to participate in

detoxification. As reported in Chapter R2, recent evidence suggests that multiple episodes of

alcohol withdrawal creates a risk of brain damage, and can contribute to seizures, alcohol-related

neuropathology and cognitive dysfunction. If this is the case, then there should be very careful

selection of clients for detoxification, and it should not be used for those who do not have the firm

intention to stop drinking. Helping people to control and reduce their drinking may be more

appropriate for those who are unlikely to sustain abstinence. Ways of tackling alcohol

consumption among chronic drinkers needs further investigation.

In some cities there is a wait of up to 10 weeks for a place on a detoxification programme. In

Nottingham, Framework Housing Association has both a wet centre (Handel Street) and a

residential treatment project for heavy drinkers, with a bed earmarked for detoxification (see

Chapter R4). This provides a fast and efficient alcohol treatment service for the wet centre users.

At the wet centres in Leicester, Nottingham and Oxford, community detoxification services are

available whereby a client partakes in the programme while at home. This is more accessible than

residential treatment, as it can start promptly, but is only suitable if clients are in a hostel or

accommodation where they have strong support.

Ideally, people need to start a rehabilitation programme immediately after the detoxification

treatment but this is difficult to arrange. Detoxification services are funded by the National

Health Service, but places on alcohol rehabilitation programmes are funded by local authority

social services departments. The places are scarce (there are waits of 6-9 months in some areas)

and costly (£400-550 per week per client). Because of inadequate move-on services, some people

return to a wet centre and resume drinking after detoxification.

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The role of activities

The value of structured activities for people with mental health problems has been well

documented, and stimulated the development of sheltered workshops and clubhouses to help

people build confidence, skills and self -worth (Beard et al., 1982). Until the late 1990s, however,

only a few hostels and day centres for homeless people provided organised activities. With the

establishment of the Rough Sleepers Unit in 1999, ‘meaningful activities’ were encouraged and

have since spread widely through the homeless sector.

Activities are promoted at some wet centres, and the Booth Centre exemplifies this work. It

has four activity workers and has secured support funding through education and health

departments, the latter to provide ‘healthy activities’ such as sports and outdoor pursuits. Its

activities include basic education and skills training (such as cookery and literacy courses),

recreational and developmental pursuits (including computer use, artwork, gardening, sports and

outdoor activities), and involvement in work and volunteer training schemes, such as conservation

projects. The Anchor Centre in Leicester has secured funding from the Department for Education

and Skills for an external agency to run activities, and at the Tollington Way wet centre in north

London, tutors from Islington College run a literacy group.

Activities play an important role in helping people with alcohol problems and should be a

central feature of wet centre provision. They provide opportunities for the constructive use of

time as a diversion from drinking, and are a platform for building skills, confidence and a sense of

achievement and self -esteem. They promote social interaction and inte gration through group

work, and encourage decision-making and planning for the future. Many chronic heavy drinkers

have cognitive impairment, short-term memory loss, and poor concentration and physical co-

ordination. Activities help to improve or compensate for these deficits.

Running activities successfully is a complex task and it is strongly recommended that wet

centres seek expert help. Success depends to some extent on the ability of tutors or activity

leaders to engage and inspire participants. A useful guide on providing learning opportunities for

homeless people, based on a programme developed by The City Literary Institute and

homelessness agencies in central London, has been commissioned by the Learning and Skills

Development Agency (Cameron et al., 2003). The guide has case study examples and covers

building partnerships, offering learners flexibility and choice, and health and safety. For

homelessness agency staff who are interested in developing learning activities for their clients, it

recommends that contacts should initially be made with: (i) the community education co-ordinator

at a further education college; and (ii) the adult and community learning service of the local

education authority.

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M4 Managing the centre

Wet day centres have two linked roles, to engage with street drinkers and help them deal with

their problems, and to reduce street drinking and its associated anti-social behaviour and negative

environmental impacts. As has been made clear elsewhere in this report, these exceptionally

demanding roles are difficult to sustain. This chapter details the most apparent problems of

running a centre, how they arise, and how they have been contained and solved at the currently

operating centres. The following accounts therefore draw almost entirely from the experience and

successes of the centres that have contributed to this study.

Staffing

To be effective in delivering its functions, a wet centre requires sufficient staff:

• To provide a safe setting for its users, staff and volunteers.

• To provide basic services to the clients and programmes of constructive and rewarding activities.

• To facilitate individualised work with the clients that involves care planning, support, monitoring, and liaising with other agencies.

• To induct new members of staff and volunteers, and provide cover for holiday and sickness absence.

• To undertake routine performance recording and reviews.

• To enable the managers to develop and maintain contacts with other services, professionals and the local community.

• To allow time for the staff to attend appraisal, supervision and training sessions.

At least one staff member should be a trained first-aider, as accidents and seizures are common

among the client group, and one responsible person should have detailed, up-to-date knowledge

about how to enlist emergency support from primary health care professionals, the mental health

services, and the police.

Skills and roles

There are two main kinds of work with the clients in wet day centres. Front-line work includes

the day-to-day running of the centre and supporting the clients when they first attend. It involves

delivering basic services such as drinks, meals, standard information and advice (for example

about the payment of utility bills), and engaging, getting to know and building trust with the

attenders. Front-line workers need to be capable of developing rapport with distrustful and

disturbed clients, of managing boisterous exchanges, and directly controlling unruly, threatening

or disallowed behaviour. Both staff and volunteers need a clear understanding of the situations in

which they should intervene alone, only with support or help, or not at all. They also need a

general awareness of what is happening on the streets and in the clients’ lives.

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The other type of work is with established clients and is individualised. It includes assessing

clients’ needs, and formulating, implementing and reviewing care-plans with the client. In some

centres it is informally organised and even opportunistic; in others it is systematically organised

as ‘case-work’. The worker requires skills in assessing needs, identifying problems and working

out ways to address them, and in developing the client’s trust and co-operation. Case-workers

also need wide-ranging and up-to-date knowledge of the local welfare system and especially

about local specialist statutory and voluntary agencies, their roles, and the referral procedures.

Implementing the care-plans requires not only a great deal of work in persuading other agencies to

take on the clients, but also in promoting the client’s compliance, and in record keeping,

monitoring and reviewing progress.

There are also important and valuable forms of intermediate work that have, as it were, both

‘front line’ and ‘developmental’ functions. Broadly these are the activities for the attenders which

are provided and promoted through the centre. Many are organised as group activities and

initially presented as such, but provide settings in which individualised ‘assessment’, advice,

encouragement and plans can gradually be introduced. This kind of gradualist approach is

especially suitable for mistrustful and wary clients.

Organisation of the work

Regardless of how the staff are organised, a wet centre needs to have a complement of staff that

can deliver front-line work, gradualist engagement and casework. At some wet centres, all core

staff are involved in both front-line contacts with the attenders and case-work with established

clients. At Tollington Way and the Anchor Centre, some staff are dedicated to front-line work,

while others undertake case-work. The front-line workers refer clients who have been engaged

and who consent to the case-workers. At the Booth Centre, the staff engage in both kinds of

work, and give priority to (a) establishing contacts between the client and the specialist housing,

health and substance abuse agencies, and (b) involving the clients in constructive activities. At

Handel Street in Nottingham, the staff are involved in front-line work, case-work and tenancy

support to housed clients.

Staff supervision and support

It is manifest that working with the client group is intrinsically challenging and that tensions,

aggression, non-compliance and rejection are relatively common (which is why many mainstream

services debar the clients). To counter these difficulties and stresses, however paradoxical it may

seem, it is unusually important that alongside a strong client-oriented ethos, line management

functions are vigilantly applied. They have a vital role in the support and retention of the staff,

and in ensuring that the more ambitious but difficult aims of the centre are pursued. The staff

require a high level of guidance and support for they have exceptionally challenging roles.

Persuading the clients to make positive changes to their lives is far more difficult than providing a

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welcoming setting and reassuring exchange. Without the encouragement, support and supervision

of the staff, attention to the former can recede.

A tendency could occur for two departures from optimal ways of working. On the one hand,

the need to build trust and friendly relationships with the clients can predominate and delay or

exclude more reflective exchanges about a client’s problematic behaviour. In other words, the

alcohol-dependent lifestyle and dependency on the centre can go unchallenged. On the other

hand, particularly as a reaction to frequent aggression or argumentative clients and in the absence

of other forms of support, an ‘us’ and ‘them’ ambience can develop. One symptom is when the

staff retreat into ‘the office’ and shun maximum contact with the clients. While not observed in

any of the centres, in some homeless services the situation develops to the point at which the staff

see their role as primarily to ma intain order and ‘keep the lid’ on latent problems. In other words,

an exceptional degree of what amounts to professional responsibility and dedication to the

challenging roles of a wet day centre is required of the staff, and it must be expected that many

will be junior, inexperienced and low-paid.

Staff training

Staff training is essential for core staff, volunteers and sessional staff. They need to have an

understanding of alcohol dependency issues, such as why people drink, the effects of alcohol

abuse on the person and others, and the needs of heavy drinkers. Training is also necessary in

managing aggressive and challenging behaviour, and in working with people who have drug and

mental health problems. The staff who undertake case-work will additionally require training in

assessing needs, and in designing, implementing and reviewing care-plans. Those who are to be

involved in the running of activity groups will need group-work skills, while those who are to

undertake tenancy-support work will require skills in assessing the housing vulnerabilities of

clients and responding to those who are having difficulties.

Developed by ‘Skills for Health’ in collaboration with other training organisations with an

interest in substance misuse, the Drugs and Alcohol National Occupational Standards (DANOS)

were accredited by the Education Act Regulatory Bodies in October 2002, and launched in

summer 2003. These describe the standard of performance required of staff working in the field

of substance misuse and the knowledge and skills that they need. They form the basis of national

vocational qualifications (NVQs). In the good practice handbook, Drug Services for Homeless

People, prepared in 2002 by Geoffrey Randall and DrugScope, it is recommended that all staff

working with homeless drug users are trained to the standards set by DANOS. The same could be

applied to staff working with alcohol misusers. Key skills include:

• Assessing substance misusers’ needs and care;

• Helping individuals access substance misuse services;

• Supporting individuals in difficult situations;

• Educating people about substance use, health and social well-being;

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• Planning and reviewing integrated programmes of care for substance misusers;

• Supporting individuals’ rehabilitation;

• Providing a healthy, safe, secure and suitable environment for the delivery of services.

Wet centres are in their infancy. Many staff at the centres reported little opportunity to meet with

each other and discuss working practices. It is strongly recommended that resources are made

available for more forums and seminars at which staff could share their knowledge about effective

and ineffective ways of working with heavy drinkers.

Recruitment and retention

Some wet centres have experienced problems in recruiting and retaining staff, and have had a high

turnover rate and few staying for more than two years. The low wages of many voluntary sector

agencies, weekend work, and challenging and abusive clients are deterrents. Moreover, the work

involves supporting people who have been drinking heavily for years, and little or no progress is

made with a percentage. At most centres, success is achieved when a client ceases to attend and

breaks away from the drinkers’ network, while the protracted client contacts are mostly with those

who progress slowly or do not accept offered help. Hence the staff only exceptionally learn about

the successful outcomes of their advice and support: they are denied this source of job satisfaction

and reinforcement of the value of their work. Quotations from the staff describe the work as

‘emotionally draining’, ‘depressing to see the wasted skills of clients’, and ‘[I’ve been] constantly

faced with difficult behaviour; after a while it takes its toll’.

To encourage job satisfaction and staff retention and to provide continuity of care for the

clients, Handel Street Centre added tenancy support work to the role of the day centre staff. This

means that staff have to learn about both day centre and tenancy support work. On the other hand,

job applications for new posts have since increased, and the tenancy sustainment element is

believed to have been the attraction. For the staff of the Booth Centre, job satisfaction is

associated with being involved in activities and helping clients to change, and being able to

observe improvements in the clients. Hence, for wet centre staff, job satisfaction is likely to be

achieved when staff have roles that enable them to see the progress of clients. Consideration also

needs to be given to the nature of the work and the skills required when staff pay and conditions

are fixed. Staff support sessions are essential as a forum for discussing the positive and negative

aspects of working in a wet centre and as a means to improve staff morale.

The use of volunteers

The use of volunteers varies at the wet centres. The Booth Centre has both external volunteers

and a Supported Volunteering Project, whereby clients work at the centre one session a week.

The staff believe that volunteers have an important role in engaging with clients for they have the

time to talk to them (described in Chapter R4). Both the wet centres in Nottingham and Brighton

also use volunteers, many of whom have subsequently obtained jobs working with homeless

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people. They are not however used at the centres in Leicester and Oxford. The Anchor Centre

initially had volunteers but found them to be unreliable and it did not work.

Volunteers work in many social care settings, and some projects for homeless people,

particularly drop-in centres, could not survive without their contributions. A great deal has been

written about the benefits of volunteering to the volunteers, but less about their impact on clients.

The National Centre for Volunteering, established in 1973, offers a range of services to support

managers and organisations that work with volunteers, including practitioner networks,

publications, and information services (http://www.volunteering.org.uk). An Institute for

Volunteering Research has been established by the National Centre for Volunteering in

association with the Centre for Institutional Studies at the University of East London

(htttp://www.ivr.org.uk). A survey carried out by the Institute in 1998 found that four-fifths of

547 organisations (mostly in the voluntary sector) had a designated volunteer co-ordinator, and

most had systems in place for supporting and supervising the volunteers. Three-fifths also had

procedures for evaluating the volunteers’ work.

Three important principles should govern the use of volunteers at wet centres. First, they

should not be recruited to replace salaried staff but always to extend and improve the quality of

service provision. Second, because of the problems and behaviour of the clients, volunteers must

receive systematic training, supervision and support. The training requirement is greater than in a

generalist day centre for homeless people and undoubtedly increases the workload of staff.

Careful consideration therefore needs to be given to the benefits of having volunteers in wet

centres, and whether these outweigh the additional workload for staff.

The third principle concerns engaging clients or former clients as volunteers. The Booth

Centre trains clients as helpers on the activity programmes but not at drop-in sessions. They are

involved in practical tasks but not in giving confidential advice to or decision-making with clients.

Tollington Way in London also has one such volunteer. Involving clients as volunteer helpers is

more complex than ‘non-client’ volunteers, as some may still be involved in the street networks.

They will require a great deal of training, supervision and support, and clear boundaries around

confidentiality and roles will have to be set. The clients who become volunteers obtain a

constructive role in a safe and familiar setting, while they gain confidence and skills. Their

involvement at the wet centre should therefore be an interim step to other voluntary work or

training.

Maintaining links with specialist agencies

The importance of establishing links with specialist agencies has been described in Chapter R2.

These contacts should continue and develop once the centre is operating. The most appropriate

and cost-effective ways of working for both the clients and the service-providers should be

explored. When the Anchor Centre first opened, a social worker worked at the project one day

each week but the workload was insufficient. The time was reduced to one-half day weekly, but

the staff can contact the social worker at any time and arrange for clients to be seen.

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Regular meetings should be held with all relevant agencies, including street outreach

workers, to discuss (i) the wet centre’s impacts on the local area, its effectiveness in targeting

street drinkers and other street people, and its contribution to local homelessness strategies; and

(ii) the services that are provided by the wet centre, and gaps in service provision.

Control in the centre

The functions of wet centres include working supportively with people who have challenging

behaviour and, at the same time, providing a safe environment where the attenders are helped. It

is essential therefore that the centre is well-managed, the staff maintain control, and that clear

boundaries are set for the clients. If this does not happen, there is a likelihood of bullying,

intimidation and attempts by the clients to control who comes into the centre. These problems

occurred at both Tollington Way and the Anchor Centre, and resulted in volatile and intimidatory

situations and some vulnerable clients staying away. Since the introduction of stricter regimes

and a barring policy at both centres, there are fewer arguments and less violence. Moreover, the

clients who were barred have returned and their behaviour has improved. The staff believe that

barring gives clients a reason to control their behaviour, and sends a message to other clients

about unacceptable behaviour. Control in the current centres is maintained in the following ways:

1. Restriction of the number of clients admitted at any one time, particularly if the centre is small, and having staff at the entrance to admit clients.

2. Stipulating rules about behaviour in the centre and in its immediate environs, and adopting a barring policy. People are generally barred as a result of (i) violent or threatening behaviour which puts the safety of the clients or staff at risk, or (ii) infringements of the rules which have serious implications on the service, such as dealing in illegal drugs on the premises. People who are intoxicated and behave in a threatening manner are asked to leave that day, while bans of one week or more are imposed for more serious incidents.

3. Challenging clients who are abusive or threatening and working with them to control their behaviour, rather than imposing long-term bans. It is pointless to confront them on the day of the incident if they are intoxicated, but the problem should be addressed subsequently. The Anchor Centre has a ‘behaviour contract’ which barred clients have to sign before they are readmitted.

4. Recognising the practical limitations of the staff’s ability to manage extremely difficult behaviour.

Managing the local environment

It is essential that clear procedures are in place for the management of the local environment of a

wet centre and to minimise its impact on the neighbourhood. Ways of initially gaining support

and reducing opposition from local businesses and residents were discussed in Chapter M2.

Regular meetings with the local community should continue once the centre has opened to

provide opportunities to air views and raise concerns. Even at the centres which have been open

for a few years, there are still intermittent concerns and complaints from the local community. At

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Tollington Way in London, the meetings lapsed after the centre opened but the staff now realise

that this should not have happened.

It is important that the wet centre managers and staff respond when concerns are

expressed. At Tollington Way, for example, when the staff received complaints about the clients’

behaviour outside the centre, they met with the clients and agreed a code of conduct. Similarly at

the Anchor Centre, the council and the centre staff worked with the theatre next door to overcome

problems (see Chapter R4). At the Specialist Dependency Service in Camden Town, London, one

of the manager’s roles is to liaise with local residents and businesses. They have the centre’s

phone number and can ring if, for example, someone is sitting in their doorway. The staff will

come out and talk to the person. The centre’s ‘Neighbourhood Management Policy’ describes the

staff’s responsibilities and commitment. Included are:

• The staff on duty will ensure that there is no disruptive behaviour in the immediate vicinity during the half-hour before opening and after closing.

• At the beginning of each shift, one member of the team will be designated to carry out health and safety checks every thirty minutes while the service is open. These checks will include the area immediately outside the entrance, and the team member will collect litter discarded by the clients.

• The service will not accept people who are behaving in a disorderly or aggressive manner. The team on duty will ensure that people behaving in an antisocial manner leave the immediate area and they will involve the police if necessary.

Standards, targets and performance monitoring

A widespread weakness in many voluntary sector homeless people’s services is that very little

time and effort is given to setting standards and targets, and to performance recording and

monitoring. Traditionally, it has been extremely hard for day centres to assess accurately the

quality of their services, particularly those which attract many attenders and have a high client

turnover. The organisations consequently have great difficulties in demonstrating their

achievements and in securing competitive funding.

Over the last few years, progress has been made in the development of standards which

are relevant to homeless people’s services, although their implementation in the homeless sector is

still in its infancy. Quality in Alcohol and Drug Services standards (QuADS) were commissioned

by the Department of Health to help improve standards in the substance misuse field. Produced

by DrugScope and Alcohol Concern in 1999, QuADS are measurable standards which describe

minimum and good practice for the provision of drug and alcohol services. They fall into five

groups: (i) core management standards; (ii) core service-user charter standards; (iii) core care

standards; (iv) service specific standards; and (v) target group standards. DrugScope have since

worked with more than 300 drug treatment services throughout England to implement QuADS,

and because of its work with drug users, the Leicester wet centre is participating. Commissioners

of alcohol services are increasingly expecting alcohol agencies to meet the QuADS standards.

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The Service Audit Partnership, funded by the Association of London Government, is a

mutual auditing scheme to improve the quality and safety of projects for homeless people through

a programme of peer audits. It has developed a Day Centre Sub Group, with members from

Broadway, The Passage, The London Connection and St Martin’s Social Care Unit. The Group is

adapting the auditing methods and tools of the National Housing Federation Framework for

Housing with Support for use in day centres. Day centre characteristics and services are rated

according to: (i) basic; (ii) high; and (iii) very high standards. The document can be downloaded

(http://www.serviceaudit.org). The topics covered include the extent to which day centres have:

• clear aims and objectives, and strategies that encourage targeted groups to attend and collect participation data;

• written information for service users and referral agencies;

• procedures for the formal assessment of clients’ needs and for planning care;

• procedures to manage and reduce risk;

• referral arrangements with other services;

• respectful and supportive relationships between staff and clients;

• staffing levels that reflect an appropriate workload to provide a safe service that meets users’ needs;

• clear appraisal and supervision procedures for staff;

• staff and volunteers that are appropriately trained;

• buildings fit for their purpose with facilities that are required by clients.

Targets and performance monitoring

An intrinsic problem for wet day centres is that measuring the prevention and rehabilitation

achievements is unusually difficult, partly because there is no way of counting none-events (such

as a person not becoming homeless or not causing a disturbance in a public place), and partly

because those who give up problematic drinking or a drug habit may do so when their contacts

with a day centre cease. The Anchor Centre and Booth Centre have long lists of performance

indicators which focus on the number of clients who are helped by the staff and who are linked

into other services (Chapter R4). The Anchor Centre also uses an assessment form to determine

individual changes in substance misuse, and information is gathered to monitor housing

outcomes. Straightforward and more evaluative indicators of the ways in which a day centre’s

interventions ‘change lives’ can be readily recorded and compiled (Box 1).

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Box 1 Performance indicators at a wet day centre

Straightforward indicators

Referrals to temporary accommodation

Clients rehoused in permanent accommodation

Rough sleepers referred to outreach teams

Helped by substance misuse workers

Helped to register with a GP

Helped to claim (additional) social security benefits

Assessed by mental health services

Birth certificates and other identity papers obtained

Helped to make arrangements to pay off rent arrears or utility debts

Participated in a tenancy support programme

Helped to budget weekly income

Participated in activities

Started education, training, employment or voluntary work

Evaluative indicators

The outcomes after six and twelve months for clients who are rehoused

Improvement in eating habits, i.e. had cooked meals more frequently

Changes over time in alcohol consumption (amount or type of alcohol consumed)

Reduction in street drinking

Changes over time in morale and motivation

Learned (or rebuilt) life-skills such as budgeting or cooking at the centre

Summary

The fundamental challenges that wet day centres face are to provide a welcoming and supportive

facility for vulnerable groups of clients focussed on street drinkers (some of whom are chaotic,

unco-operative and aggressive), to be pro-active in challenging their anti-social and self -harming

behaviour, and to do both of these things with low paid and sometimes inexperienced staff. The

work is far from conventional or routine, and many of the usual kinds of job-satisfaction and

career progression do not apply. Relatively intensive and continuous supervision and staff

support are required. A centre’s management (or its parent organisation) must also work hard at

developing and sustaining the collaboration and support of many other agencies, both to ensure

that the people who can benefit from its services know about the facility and attend, and to gain

access to the several specialist services that the clients will require. The aims, working practices

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and ‘tolerances’ of the centre must be fully understood and accepted by the local police and the

benefits, housing, primary health care, social service, addiction and mental health services.

maintaining the effectiveness of these links is a continuing and demanding task.

If the ‘internal focus’ and ‘external network’ attributes are well maintained, the evidence

suggests that a ‘wet day centre’ will directly provide and establish access to a remarkable range

and volume of support and treatment services. They will make an impressive contribution to the

reduction of unmet needs among the most vulnerable people in our society, and in very real ways

change people’s lives. If the collaborating agencies do not train new staff and update all staff on

the work of the centre, its effectiveness will be reduced.

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